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Gustafson D, DiStefano PV, Wang XF, Wu R, Ghaffari S, Ching C, Rathnakumar K, Alibhai F, Syonov M, Fitzpatrick J, Boudreau E, Lau C, Galant N, Husain M, Li RK, Lee WL, Parekh RS, Monnier PP, Fish JE. Circulating small extracellular vesicles mediate vascular hyperpermeability in diabetes. Diabetologia 2024; 67:1138-1154. [PMID: 38489029 PMCID: PMC11058313 DOI: 10.1007/s00125-024-06120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/30/2024] [Indexed: 03/17/2024]
Abstract
AIMS/HYPOTHESIS A hallmark chronic complication of type 2 diabetes mellitus is vascular hyperpermeability, which encompasses dysfunction of the cerebrovascular endothelium and the subsequent development of associated cognitive impairment. The present study tested the hypothesis that during type 2 diabetes circulating small extracellular vesicles (sEVs) exhibit phenotypic changes that facilitate pathogenic disruption of the vascular barrier. METHODS sEVs isolated from the plasma of a mouse model of type 2 diabetes and from diabetic human individuals were characterised for their ability to disrupt the endothelial cell (EC) barrier. The contents of sEVs and their effect on recipient ECs were assessed by proteomics and identified pathways were functionally interrogated with small molecule inhibitors. RESULTS Using intravital imaging, we found that diabetic mice (Leprdb/db) displayed hyperpermeability of the cerebrovasculature. Enhanced vascular leakiness was recapitulated following i.v. injection of sEVs from diabetic mice into non-diabetic recipient mice. Characterisation of circulating sEV populations from the plasma of diabetic mice and humans demonstrated increased quantity and size of sEVs compared with those isolated from non-diabetic counterparts. Functional experiments revealed that sEVs from diabetic mice or humans induced the rapid and sustained disruption of the EC barrier through enhanced paracellular and transcellular leak but did not induce inflammation. Subsequent sEV proteome and recipient EC phospho-proteome analysis suggested that extracellular vesicles (sEVs) from diabetic mice and humans modulate the MAPK/MAPK kinase (MEK) and Rho-associated protein kinase (ROCK) pathways, cell-cell junctions and actin dynamics. This was confirmed experimentally. Treatment of sEVs with proteinase K or pre-treatment of recipient cells with MEK or ROCK inhibitors reduced the hyperpermeability-inducing effects of circulating sEVs in the diabetic state. CONCLUSIONS/INTERPRETATION Diabetes is associated with marked increases in the concentration and size of circulating sEVs. The modulation of sEV-associated proteins under diabetic conditions can induce vascular leak through activation of the MEK/ROCK pathway. These data identify a new paradigm by which diabetes can induce hyperpermeability and dysfunction of the cerebrovasculature and may implicate sEVs in the pathogenesis of cognitive decline during type 2 diabetes.
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Affiliation(s)
- Dakota Gustafson
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Peter V DiStefano
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Xue Fan Wang
- Division of Fundamental Neurobiology, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada
| | - Ruilin Wu
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Siavash Ghaffari
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Crizza Ching
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | | | - Faisal Alibhai
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Michal Syonov
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Jessica Fitzpatrick
- Department of Medicine and Pediatrics, Women's College Hospital, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Emilie Boudreau
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Cori Lau
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Natalie Galant
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Mansoor Husain
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Ren-Ke Li
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Warren L Lee
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
- Department of Biochemistry, University of Toronto, Toronto, ON, Canada
| | - Rulan S Parekh
- Department of Medicine and Pediatrics, Women's College Hospital, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Philippe P Monnier
- Division of Fundamental Neurobiology, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada
- Donald K. Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jason E Fish
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
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2
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Pol SJ, Selkirk EK, Damer A, Mucsi I, Abbey S, Edwards B, Fung K, Gill J, Neves P, Ng SY, Parekh RS, Wright L, Wu M, Anthony SJ. "Weighing the Pros and Cons of Everything": A Qualitative Descriptive Study Exploring Perspectives About Living Donor Kidney Transplantation From Parents of Chinese Canadian Pediatric Patients With Chronic Kidney Disease. Can J Kidney Health Dis 2024; 11:20543581241249872. [PMID: 38737938 PMCID: PMC11088299 DOI: 10.1177/20543581241249872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/21/2024] [Indexed: 05/14/2024] Open
Abstract
Background As of 2021, more than 6000 children and youth in Canada were living with end-stage kidney disease (ESKD), for which kidney transplantation is considered the preferred treatment by health professionals. Research shows that living donor kidney transplantation (LDKT) has superior allograft and recipient survival compared to deceased donor kidney transplantation (DDKT). However, in a pediatric setting, the choice of LDKT or DDKT is a summative consideration of factors weighed carefully by the patient's family, health care team, and patient. Decision-making surrounding transplantation may be more complex for racial and ethnic minorities as culturally specific values and beliefs are interwoven within dominant understandings and concepts of health and accepted models of health care. For example, Chinese Canadians have an increased risk of ESKD, yet reduced access to LDKT compared to White patients, despite being the largest visible minority population in Canada. Objective The objective of this qualitative study is to deepen our understandings of the decision-making process surrounding DDKT versus LDKT among parents of Chinese Canadian pediatric patients with chronic kidney disease (CKD). Design Qualitative descriptive study design. Setting The Nephrology Program at The Hospital for Sick Children in Toronto, Canada. Participants Caregivers of Chinese Canadian patients with CKD, 18 years of age or older, and who spoke English, Cantonese, or Mandarin. Methods One-on-one, semistructured interviews were conducted virtually, by a member of the research team and were audio-recorded and transcribed verbatim. Thematic analysis was used to explore participants' shared experience. Results Seven interviews were conducted with 6 mothers and 1 father of 6 Chinese Canadian pediatric patients with CKD: 4 patients had undergone a kidney transplant, and 2 were not yet listed for transplant. Analysis of data highlighted that cultural influences affected whether parents shared with others about their child's illness and experience. The cultural understanding that it is inappropriate to burden others contributed to the creation of an isolating experience for participants. Cultural influences also impacted whether parents asked others to be a living donor as participants articulated this would place a physical burden on the living donor (e.g., potential risk to their health) and an emotional burden on the participant as they would be indebted to a willing donor. Ultimately, parents' decision to choose DDKT or LDKT for their patient-child was a result of evaluating both options carefully and within an understanding that the ideal treatment choice reflected what was best for all family members. Limitations Findings reflect experiences of a small sample from a single recruitment site which may limit transferability. Conclusions Parents in this study felt that they had access to the necessary evidence-based information to make an informed decision about the choice of DDKT versus LDKT for their child. Participant narratives described feeling isolated within cultural communities of family and friends and participants' suggestion of benefiting from increased support may guide future research directions. Practitioners can offer direct and indirect support to families, with recognition of the importance of cultural values and family-centered care on decision-making within families. Opportunities are needed for accessible, virtual social support platforms to increase parental feelings of culturally mediated peer support from parents who share similar experiences.
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Affiliation(s)
- Sarah J. Pol
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | - Enid K. Selkirk
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alameen Damer
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | - Istvan Mucsi
- Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Division of Nephrology, University of Toronto, ON, Canada
| | - Susan Abbey
- Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Beth Edwards
- Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Kenneth Fung
- Department of Psychiatry, University of Toronto, ON, Canada
| | - Jagbir Gill
- Division of Nephrology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Kidney Transplant Program, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Paula Neves
- Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Suk Yin Ng
- Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Rulan S. Parekh
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medicine, Women’s College Hospital, Toronto, ON, Canada
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Linda Wright
- Department of Surgery, University of Toronto, ON, Canada
| | - Minglin Wu
- Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Samantha J. Anthony
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada
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3
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Robinson CH, Aman N, Banh T, Brooke J, Chanchlani R, Dhillon V, Langlois V, Levin L, Licht C, McKay A, Noone D, Parikh A, Pearl R, Radhakrishnan S, Rowley V, Teoh CW, Vasilevska-Ristovska J, Parekh RS. Impact of childhood nephrotic syndrome on obesity and growth: a prospective cohort study. Pediatr Nephrol 2024:10.1007/s00467-024-06370-0. [PMID: 38637343 DOI: 10.1007/s00467-024-06370-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Children with nephrotic syndrome are at risk of obesity and growth impairment from repeated steroid treatment. However, incidence and risk factors for obesity and short stature remain uncertain, which is a barrier to preventative care. Our aim was to determine risk, timing, and predictors of obesity and short stature among children with nephrotic syndrome. METHODS We evaluated obesity and longitudinal growth among children (1-18 years) enrolled in Insight into Nephrotic Syndrome: Investigating Genes, Health, and Therapeutics. We included children with nephrotic syndrome diagnosed between 1996-2019 from the Greater Toronto Area, Canada, excluding congenital or secondary nephrotic syndrome. Primary outcomes were obesity (body mass index Z-score ≥ + 2) and short stature (height Z-score ≤ -2). We evaluated prevalence of obesity and short stature at enrolment (< 1-year from diagnosis) and incidence during follow-up. Cox proportional hazards models determined the association between nephrotic syndrome classification and new-onset obesity and short stature. RESULTS We included 531 children with nephrotic syndrome (30% frequently relapsing by 1-year). At enrolment, obesity prevalence was 23.5%, 51.8% were overweight, and 4.9% had short stature. Cumulative incidence of new-onset obesity and short stature over median 4.1-year follow-up was 17.7% and 3.3% respectively. Children with frequently relapsing or steroid dependent nephrotic syndrome within 1-year of diagnosis were at increased risk of new-onset short stature (unadjusted hazard ratio 3.99, 95%CI 1.26-12.62) but not obesity (adjusted hazard ratio 1.56, 95%CI 0.95-2.56). Children with ≥ 7 and ≥ 15 total relapses were more likely to develop obesity and short stature, respectively. CONCLUSIONS Obesity is common among children with nephrotic syndrome early after diagnosis. Although short stature was uncommon overall, children with frequently relapsing or steroid dependent disease are at increased risk of developing short stature. Effective relapse prevention may reduce steroid toxicity and the risk of developing obesity or short stature.
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Affiliation(s)
- Cal H Robinson
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nowrin Aman
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tonny Banh
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Josefina Brooke
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rahul Chanchlani
- Division of Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Vaneet Dhillon
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Valerie Langlois
- Division of Nephrology, Department of Paediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Leo Levin
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
- Program in Cell Biology, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ashlene McKay
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Damien Noone
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Alisha Parikh
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rachel Pearl
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, William Osler Health Systems, 20 Lynch Street, Brampton, Ontario, L6W 2Z8, Canada
| | - Seetha Radhakrishnan
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Veronique Rowley
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Chia Wei Teoh
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | | | - Rulan S Parekh
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.
- Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada.
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
- Department of Medicine, Women's College Hospital and University of Toronto, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.
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Lowe-Jones R, Ethier I, Fisher LA, Wong MM, Thompson S, Nakhoul G, Sandal S, Chanchlani R, Davison SN, Ghimire A, Jindal K, Osman MA, Riaz P, Saad S, Sozio SM, Tungsanga S, Cambier A, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Parekh RS, Anand S. Capacity for the management of kidney failure in the International Society of Nephrology North America and the Caribbean region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:83-96. [PMID: 38618503 PMCID: PMC11010606 DOI: 10.1016/j.kisu.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 04/16/2024] Open
Abstract
The International Society of Nephrology Global Kidney Health Atlas charts the availability and capacity of kidney care globally. In the North America and the Caribbean region, the Atlas can identify opportunities for kidney care improvement, particularly in Caribbean countries where structures for systematic data collection are lacking. In this third iteration, respondents from 12 of 18 countries from the region reported a 2-fold higher than global median prevalence of dialysis and transplantation, and a 3-fold higher than global median prevalence of dialysis centers. The peritoneal dialysis prevalence was lower than the global median, and transplantation data were missing from 6 of the 10 Caribbean countries. Government-funded payments predominated for dialysis modalities, with greater heterogeneity in transplantation payor mix. Services for chronic kidney disease, such as monitoring of anemia and blood pressure, and diagnostic capability relying on serum creatinine and urinalyses were universally available. Notable exceptions in Caribbean countries included non-calcium-based phosphate binders and kidney biopsy services. Personnel shortages were reported across the region. Kidney failure was identified as a governmental priority more commonly than was chronic kidney disease or acute kidney injury. In this generally affluent region, patients have better access to kidney replacement therapy and chronic kidney disease-related services than in much of the world. Yet clear heterogeneity exists, especially among the Caribbean countries struggling with dialysis and personnel capacity. Important steps to improve kidney care in the region include increased emphasis on preventive care, a focus on home-based modalities and transplantation, and solutions to train and retain specialized allied health professionals.
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Affiliation(s)
- Racquel Lowe-Jones
- Department of Medicine, Cayman Islands Health Services Authority, Georgetown, Grand Cayman, Cayman Islands
| | - Isabelle Ethier
- Division of Nephrology, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
- Health Innovation and Evaluation hub, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Lori-Ann Fisher
- Department of Medicine, University Hospital of the West Indies, Kingston, Jamaica
- University of West Indies, Kingston, Jamaica
| | - Michelle M.Y. Wong
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Thompson
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Georges Nakhoul
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sara N. Davison
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anukul Ghimire
- Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kailash Jindal
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed A. Osman
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Parnian Riaz
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Syed Saad
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Stephen M. Sozio
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Somkanya Tungsanga
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of General Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Alexandra Cambier
- Division of Pediatric Nephrology, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rulan S. Parekh
- Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shuchi Anand
- Department of Medicine (Nephrology), Stanford University, Palo Alto, California, USA
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Parekh RS. The Road to APOL1 Genetic Testing in Transplantation. Clin J Am Soc Nephrol 2024; 19:415-417. [PMID: 38598196 PMCID: PMC11025684 DOI: 10.2215/cjn.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Rulan S Parekh
- Department of Medicine and Pediatrics, Women's College Hospital, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Adamson WE, Noyes H, Johnson P, Cooper A, Monckton DG, Ogunsola J, Beckett-Hill G, Sullivan M, Mark P, Parekh RS, MacLeod A. Phenome-wide analysis reveals epistatic associations between APOL1 variants and chronic kidney disease and multiple other disorders. EBioMedicine 2024; 101:105000. [PMID: 38360481 PMCID: PMC10944146 DOI: 10.1016/j.ebiom.2024.105000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND APOL1 variants G1 and G2 are common in populations with recent African ancestry. They are associated with protection from African sleeping sickness, however homozygosity or compound heterozygosity for these variants is associated with chronic kidney disease (CKD) and related conditions. What is not clear is the extent of associations with non-kidney-related disorders, and whether there are clusters of diseases associated with individual APOL1 genotypes. METHODS Using a cohort of 7462 UK Biobank participants with recent African ancestry, we conducted a phenome-wide association study investigating associations between individual APOL1 genotypes and conditions identified by the International Classification of Disease phenotypes. FINDINGS We identified 27 potential associations between individual APOL1 genotypes and a diverse range of conditions. G1/G2 compound heterozygotes were specifically associated with 26 of these conditions (all deleteriously), with an over-representation of infectious diseases (including hospitalisation and death resulting from COVID-19). The analysis also exposed complexities in the relationship between APOL1 and CKD that are not evident when risk variants are grouped together: G1 homozygosity, G2 homozygosity, and G1/G2 compound heterozygosity were each shown to be associated with distinct CKD phenotypes. The multi-locus nature of the G1/G2 genotype means that its associations would go undetected in a standard genome-wide association study. INTERPRETATION Our findings have implications for understanding health risks and better-targeted detection, intervention, and therapeutic strategies, particularly in populations where APOL1 G1 and G2 are common such as in sub-Saharan Africa and its diaspora. FUNDING This study was funded by the Wellcome Trust (209511/Z/17/Z) and H3Africa (H3A/18/004).
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Affiliation(s)
- Walt E Adamson
- School of Biodiversity, One Health, and Veterinary Medicine, University of Glasgow, United Kingdom; Wellcome Centre for Integrative Parasitology, University of Glasgow, United Kingdom; TrypanoGEN+ Research Group, Uganda, Member of the H3Africa Consortium, South Africa.
| | - Harry Noyes
- TrypanoGEN+ Research Group, Uganda, Member of the H3Africa Consortium, South Africa; Centre for Genomic Research, University of Liverpool, United Kingdom
| | - Paul Johnson
- School of Biodiversity, One Health, and Veterinary Medicine, University of Glasgow, United Kingdom
| | - Anneli Cooper
- School of Biodiversity, One Health, and Veterinary Medicine, University of Glasgow, United Kingdom; Wellcome Centre for Integrative Parasitology, University of Glasgow, United Kingdom
| | - Darren G Monckton
- School of Molecular Biosciences, University of Glasgow, United Kingdom
| | - John Ogunsola
- School of Biodiversity, One Health, and Veterinary Medicine, University of Glasgow, United Kingdom; Wellcome Centre for Integrative Parasitology, University of Glasgow, United Kingdom
| | - Georgia Beckett-Hill
- School of Biodiversity, One Health, and Veterinary Medicine, University of Glasgow, United Kingdom
| | - Michael Sullivan
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom
| | - Patrick Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom
| | - Rulan S Parekh
- Women's College Hospital, Hospital for Sick Children and University of Toronto, Canada
| | - Annette MacLeod
- School of Biodiversity, One Health, and Veterinary Medicine, University of Glasgow, United Kingdom; Wellcome Centre for Integrative Parasitology, University of Glasgow, United Kingdom; TrypanoGEN+ Research Group, Uganda, Member of the H3Africa Consortium, South Africa.
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7
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Auguste BL, Nadeau-Fredette AC, Parekh RS, Poyah PS, Perl J, Sood MM, Tangri N. A Canadian Commentary on the NKF-ASN Task Force Recommendations on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. Kidney Med 2024; 6:100746. [PMID: 38143561 PMCID: PMC10746381 DOI: 10.1016/j.xkme.2023.100746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Abstract
In 2021, a committee was commissioned by the Canadian Society of Nephrology to comment on the 2021 National Kidney Foundation-American Society of Nephrology Task Force recommendations on the use of race in glomerular filtration rate estimating equations. The committee met on numerous occasions and agreed on several recommendations. However, the committee did not achieve unanimity, with a minority group disagreeing with the scope of the commentary. As a result, this report presents the viewpoint of the majority members. We endorsed many of the recommendations from the National Kidney Foundation-American Society of Nephrology Task Force, most importantly that race should be removed from the estimated glomerular filtration rate creatinine-based equation. We recommend an immediate implementation of the new Chronic Kidney Disease Epidemiology Collaboration equation (2021), which does not discriminate among any group while maintaining precision. Additionally, we recommend that Canadian laboratories and provincial kidney organizations advocate for increased testing and access to cystatin C because the combination of cystatin C and creatinine in revised equations leads to more precise estimates. Finally, we recommend that future research studies evaluating the implementation of the new equations and changes to screening, diagnosis, and management across provincial health programs be prioritized in Canada.
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Affiliation(s)
- Bourne L. Auguste
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Annie Claire Nadeau-Fredette
- Hôpital Maisonneuve-Rosemont Research Center, Department of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Rulan S. Parekh
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women’s College Hospital, Toronto, ON, Canada
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Penelope S. Poyah
- Nova Scotia Health Authority, Central Zone, Halifax, NS, Canada
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jeffrey Perl
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Nephrology, St. Michael’s Hospital, Unity Health, Toronto, ON, Canada
| | - Manish M. Sood
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Navdeep Tangri
- Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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8
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Robinson CH, Parekh RS. Treating Frequently Relapsing and Steroid-Dependent Nephrotic Syndrome: To Obi or Not to Obi, That is the Question. Clin J Am Soc Nephrol 2023; 18:1527-1529. [PMID: 37883188 PMCID: PMC10723921 DOI: 10.2215/cjn.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Cal H. Robinson
- Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rulan S. Parekh
- Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, Department of Medicine, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
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9
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Chung J, Robinson C, Sheffield L, Paramanathan P, Yu A, Ewusie J, Sanger S, Mitsnefes M, Parekh RS, Sinha MD, Rodrigues M, Thabane L, Dionne J, Chanchlani R. Prevalence of Pediatric Masked Hypertension and Risk of Subclinical Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. Hypertension 2023; 80:2280-2292. [PMID: 37737026 DOI: 10.1161/hypertensionaha.123.20967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Masked hypertension (MH) occurs when office blood pressure is normal, but hypertension is confirmed using out-of-office blood pressure measures. Hypertension is a risk factor for subclinical cardiovascular outcomes, including left ventricular hypertrophy, increased left ventricular mass index, carotid intima media thickness, and pulse wave velocity. However, the risk factors for ambulatory blood pressure monitoring defined MH and its association with subclinical cardiovascular outcomes are unclear. A systematic literature search on 9 databases included English publications from 1974 to 2023. Pediatric MH prevalence was stratified by disease comorbidities and compared with the general pediatric population. We also compared the prevalence of left ventricular hypertrophy, and mean differences in left ventricular mass index, carotid intima media thickness, and pulse wave velocity between MH versus normotensive pediatric patients. Of 2199 screened studies, 136 studies (n=28 612; ages 4-25 years) were included. The prevalence of MH in the general pediatric population was 10.4% (95% CI, 8.00-12.80). Compared with the general pediatric population, the risk ratio (RR) of MH was significantly greater in children with coarctation of the aorta (RR, 1.91), solid-organ or stem-cell transplant (RR, 2.34), chronic kidney disease (RR, 2.44), and sickle cell disease (RR, 1.33). MH patients had increased risk of subclinical cardiovascular outcomes compared with normotensive patients, including higher left ventricular mass index (mean difference, 3.86 g/m2.7 [95% CI, 2.51-5.22]), left ventricular hypertrophy (odds ratio, 2.44 [95% CI, 1.50-3.96]), and higher pulse wave velocity (mean difference, 0.30 m/s [95% CI, 0.14-0.45]). The prevalence of MH is significantly elevated among children with various comorbidities. Children with MH have evidence of subclinical cardiovascular outcomes, which increases their risk of long-term cardiovascular disease.
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Affiliation(s)
- Jason Chung
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada (J.C.)
| | - Cal Robinson
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada (C.R.)
| | - Lauren Sheffield
- Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada (L.S.)
| | - Prathayini Paramanathan
- All Saints University College of Medicine, Kingstown, Saint Vincent and the Grenadines (P.P.)
| | - Andrew Yu
- Faculty of Science, University of Alberta, Edmonton, Canada (A.Y.)
| | - Joycelyne Ewusie
- Department of Health Research Methods, Evidence, and Impact, Research Institute - St Joseph's Healthcare Hamilton, McMaster University, Ontario, Canada (J.E., L.T.)
| | - Stephanie Sanger
- Department of Health Sciences: Health Science Library, McMaster University, Hamilton, Ontario, Canada (S.S.)
| | - Mark Mitsnefes
- Department of Pediatrics, Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.)
| | - Rulan S Parekh
- Department of Pediatrics and Medicine, Division of Nephrology, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada (R.S.P.)
| | - Manish D Sinha
- Department of Paediatric Nephrology, King's College London, Evelina London Childrens Hospital, United Kingdom (M.D.S.)
| | - Myanca Rodrigues
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (M.R.)
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, Research Institute - St Joseph's Healthcare Hamilton, McMaster University, Ontario, Canada (J.E., L.T.)
- University of Johannesburg Faculty of Health Sciences, South Africa (L.T.)
| | - Janis Dionne
- Department of Pediatrics, Division of Nephrology, University of British Columbia, Vancouver, Canada (J.D.)
| | - Rahul Chanchlani
- Department of Pediatrics, Division of Pediatric Nephrology, McMaster Children's Hospital, McMaster University, Hamilton, Canada (R.C.)
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10
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Revon-Riviere G, Young LC, Stephenson EA, Brodeur-Robb K, Cohen-Gogo S, Deyell R, Lacaze-Masmonteil T, Palmer A, Parekh RS, Whitlock JA, Morgenstern DA. Ensuring access to innovative therapies for children, adolescents, and young adults across Canada: The single patient study experience. Paediatr Child Health 2023; 28:399-403. [PMID: 37885599 PMCID: PMC10599489 DOI: 10.1093/pch/pxac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/08/2022] [Indexed: 10/28/2023] Open
Abstract
Innovative therapeutic approaches are needed to alleviate the burden of life-limiting, rare, and chronic conditions affecting children, adolescents, and young adults (CAYA). This includes a need for improved access to both clinical research and to non-approved or off-label therapies, together with, ultimately, more therapies achieving regulatory approval in Canada. The single patient study (SPS), also known as an open label individual patient (OLIP) study, was introduced by Health Canada to open access to non-marketed drugs where a clinical trial is not readily available, but the drug is considered too investigational to be managed on a standard Special Access Program. SPS is designed for patients who have a serious or life-threatening condition and have exhausted available treatment options. Our report summarizes this relatively new development in the Canadian regulatory environment and highlights the opportunities and challenges as identified by regulators, pharmaceutical representatives, academic researchers, and patient/parent advocates.
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Affiliation(s)
- Gabriel Revon-Riviere
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Leah C Young
- C17 Council, University of Alberta, Edmonton, Alberta, Canada
| | - Elizabeth A Stephenson
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Sarah Cohen-Gogo
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Deyell
- Department of Paediatrics, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Thierry Lacaze-Masmonteil
- Department of Paediatrics, Cumming School of Medicine and University of Calgary, Calgary, Alberta, Canada
| | - Antonia Palmer
- Kindred Foundation, Oakville, Ontario, Canada
- Advocacy for Canadian Childhood Oncology Research Network (Ac2orn), Canada
| | - Rulan S Parekh
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Women’s College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - James A Whitlock
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Daniel A Morgenstern
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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11
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Marchel D, Trachtman H, Larkina M, Helmuth M, Lai Yee JY, Fermin D, Bomback AS, Canetta PA, Gipson DS, Mottl AK, Parekh RS, Saha MK, Sampson MG, Lafayette RA, Mariani LH. The Significance of Hematuria in Podocytopathies. Clin J Am Soc Nephrol 2023; 19:01277230-990000000-00251. [PMID: 37733352 PMCID: PMC10843204 DOI: 10.2215/cjn.0000000000000309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Hematuria is frequently present in podocytopathies, but its significance and prognostic value is not well described in these proteinuric kidney diseases. This study describes the prevalence and association between hematuria and kidney-related outcomes in these disorders. METHODS Hematuria was assessed at the initial urinalysis in participants with the following podocytopathies, membranous nephropathy, minimal change disease, and focal segmental glomerulosclerosis, in the Nephrotic Syndrome Study Network (NEPTUNE) and Cure Glomerulonephropathy (CureGN) cohorts with >24 months of follow-up. Multivariable Cox proportional hazards models were fit for time to composite outcome (end-stage kidney disease or 40% decline in estimated glomerular filtration rate (eGFR) and eGFR <60 ml/min/1.73 m2) and proteinuria remission (UPCR <0.3 mg/mg). RESULTS Among the 1,516 adults and children in the study, 528 (35%) participants had focal segmental glomerulosclerosis, 499 (33%) had minimal change disease, and 489 (32%) had membranous nephropathy. Median (IQR) time from biopsy until the initial study urinalysis was 260 days (49, 750), and 498 (33%) participants were positive for hematuria. Participants with hematuria compared to those without, were older (37 [16, 55] vs 33 years [12, 55]), more likely to have an underlying diagnosis of membranous nephropathy (44% vs 27%), had shorter time since biopsy (139 [27, 477] vs 325 [89, 878] days) and higher UPCR (3.8 [1.4, 8.0] vs 0.9 [0.1, 3.1]g/g). After adjusting for diagnosis, age, sex, UPCR, eGFR, time since biopsy, and study cohort, hematuria was associated with a higher riskof reaching the composite outcome (HR 1.31 [1.04, 1.65], p-value 0.02) and lower rate of reaching proteinuria remission (HR 0.80 [0.65-0.98], p-value 0.03). CONCLUSIONS Hematuria is prevalent among participants with the three podocytopathies and is significantly and independently associated with worse kidney-related outcomes, including both progressive loss of kidney function remission of proteinuria.
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Affiliation(s)
- Dorota Marchel
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Howard Trachtman
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Maria Larkina
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Margaret Helmuth
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Y. Lai Yee
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Damian Fermin
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Andrew S. Bomback
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York
| | - Pietro A. Canetta
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York
| | - Debbie S. Gipson
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Amy K. Mottl
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina
| | - Rulan S. Parekh
- Department of Medicine and Pediatrics, Women's College Hospital, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Manish K. Saha
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina
| | - Matthew G. Sampson
- Division of Pediatric Nephrology, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Kidney Disease Initiative and Medical Population Genetics Groups, Broad Institute, Cambridge, Massachusetts
- Division of Kidney Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard A. Lafayette
- Division of Nephrology, Stanford University Medical Center, Stanford, California
| | - Laura H. Mariani
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
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12
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Aman NF, Fitzpatrick J, de Verteuil I, Vasilevska-Ristovska J, Banh THM, Korczak DJ, Parekh RS. Family functioning and quality of life among children with nephrotic syndrome during the first pandemic wave. Pediatr Nephrol 2023; 38:3193-3198. [PMID: 36459245 PMCID: PMC9716160 DOI: 10.1007/s00467-022-05809-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/29/2022] [Accepted: 10/24/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND During the SARS-CoV-2 global pandemic, one of the longest lockdowns worldwide occurred in Ontario, Canada, during the first wave. For parents and children managing care at home and at risk for COVID-19, the impact on their psychosocial functioning is unknown. METHODS A total of 122 families of children aged 2-18 years were enrolled as part of the prospective cohort of childhood nephrotic syndrome and completed a survey during the first wave of the pandemic (August 21-December 10), 2020. In a subset, 107 families had data available pre-pandemic to assess change. Validated measures included the McMaster Family Assessment Device (FAD) for parents and children ≥ 12 years for family functioning, the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) for both parent and child, and Pediatric Quality of Life Inventory (PEDSQL™-V4) for children only. Scores were compared using Student's t-test or the Mann-Whitney U test, as appropriate. RESULTS Among the 107 children, 71% were male with a mean age of 9 years old at the time of questionnaire completion, and the mean age of parents was 41 years old. Parents and children reported that family functioning improved during COVID (parent: p < 0.01; child: p = 0.05). Children's overall HRQOL declined (p = 0.04), specifically increased sleep disruption (p = 0.01). Increasing child age was associated with a greater sleep disruption (β = - 1.6 [IQR: - 2.6, - 0.67]) and a related decrease in QOL (β = - 1.0 [IQR: - 1.7, - 0.2]), adjusted for sex. CONCLUSIONS Despite the positive effects of family dynamics during the first wave, there were negative effects of sleep disruptions and reduced quality of life in children, especially among older children. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Nowrin F Aman
- Child Health and Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
- Academics, Women's College Hospital, Toronto, ON, M5S 1B2, Canada
| | - Jessica Fitzpatrick
- Child Health and Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
- Department of Medicine, University of California, San Francisco, CA, 94143, USA
| | - Isabel de Verteuil
- Child Health and Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Jovanka Vasilevska-Ristovska
- Child Health and Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
- Academics, Women's College Hospital, Toronto, ON, M5S 1B2, Canada
| | - Tonny Hue Minh Banh
- Child Health and Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Daphne J Korczak
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rulan S Parekh
- Child Health and Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
- Academics, Women's College Hospital, Toronto, ON, M5S 1B2, Canada.
- Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Department of Pediatrics, Faculty of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada.
- Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
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13
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Affiliation(s)
- Liisa Am Galea
- Centre for Addiction and Mental Health, Department of Psychiatry, Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Rulan S Parekh
- Departments of Medicine, Paediatrics, Epidemiology, and Health Policy and Management Evaluation at Women's College Hospital, Hospital for Sick Children, and University of Toronto, Toronto, Canada
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14
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Downie ML, Gupta S, Chan MMY, Sadeghi-Alavijeh O, Cao J, Parekh RS, Diz CB, Bierzynska A, Levine AP, Pepper RJ, Stanescu H, Saleem MA, Kleta R, Bockenhauer D, Koziell AB, Gale DP. Shared genetic risk across different presentations of gene test-negative idiopathic nephrotic syndrome. Pediatr Nephrol 2023; 38:1793-1800. [PMID: 36357634 PMCID: PMC10154254 DOI: 10.1007/s00467-022-05789-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Idiop athic nephrotic syndrome (INS) is classified in children according to response to initial corticosteroid therapy into steroid-sensitive (SSNS) and steroid-resistant nephrotic syndrome (SRNS), and in adults according to histology into minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS). However, there is well-recognised phenotypic overlap between these entities. Genome-wide association studies (GWAS) have shown a strong association between SSNS and variation at HLA, suggesting an underlying immunological basis. We sought to determine whether a risk score generated from genetic variants associated with SSNS could be used to gain insight into the pathophysiology of INS presenting in other ways. METHODS We developed an SSNS genetic risk score (SSNS-GRS) from the five variants independently associated with childhood SSNS in a previous European GWAS. We quantified SSNS-GRS in independent cohorts of European individuals with childhood SSNS, non-monogenic SRNS, MCD, and FSGS, and contrasted them with SSNS-GRS quantified in individuals with monogenic SRNS, membranous nephropathy (a different immune-mediated disease-causing nephrotic syndrome), and healthy controls. RESULTS The SSNS-GRS was significantly elevated in cohorts with SSNS, non-monogenic SRNS, MCD, and FSGS compared to healthy participants and those with membranous nephropathy. The SSNS-GRS in all cohorts with non-monogenic INS were also significantly elevated compared to those with monogenic SRNS. CONCLUSIONS The shared genetic risk factors among patients with different presentations of INS strongly suggests a shared autoimmune pathogenesis when monogenic causes are excluded. Use of the SSNS-GRS, in addition to testing for monogenic causes, may help to classify patients presenting with INS. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Mallory L Downie
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sanjana Gupta
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Melanie M Y Chan
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Omid Sadeghi-Alavijeh
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Jingjing Cao
- Department of Medicine, Women's College Hospital, Toronto, Canada
| | - Rulan S Parekh
- Department of Medicine, Women's College Hospital, Toronto, Canada
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, Canada
| | - Carmen Bugarin Diz
- Department of Paediatric Nephrology, Evelina London and Faculty of Life Sciences, King's College London, London, UK
| | - Agnieszka Bierzynska
- Bristol Renal, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam P Levine
- Research Department of Pathology, University College London, London, UK
| | - Ruth J Pepper
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Horia Stanescu
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Moin A Saleem
- Bristol Renal, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robert Kleta
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Detlef Bockenhauer
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ania B Koziell
- Department of Paediatric Nephrology, Evelina London and Faculty of Life Sciences, King's College London, London, UK
| | - Daniel P Gale
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
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15
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Yoo S, Garg E, Elliott LT, Hung RJ, Halevy AR, Brooks JD, Bull SB, Gagnon F, Greenwood C, Lawless JF, Paterson AD, Sun L, Zawati MH, Lerner-Ellis J, Abraham R, Birol I, Bourque G, Garant JM, Gosselin C, Li J, Whitney J, Thiruvahindrapuram B, Herbrick JA, Lorenti M, Reuter MS, Adeoye OO, Liu S, Allen U, Bernier FP, Biggs CM, Cheung AM, Cowan J, Herridge M, Maslove DM, Modi BP, Mooser V, Morris SK, Ostrowski M, Parekh RS, Pfeffer G, Suchowersky O, Taher J, Upton J, Warren RL, Yeung R, Aziz N, Turvey SE, Knoppers BM, Lathrop M, Jones S, Scherer SW, Strug LJ. HostSeq: a Canadian whole genome sequencing and clinical data resource. BMC Genom Data 2023; 24:26. [PMID: 37131148 PMCID: PMC10152008 DOI: 10.1186/s12863-023-01128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/22/2023] [Indexed: 05/04/2023] Open
Abstract
HostSeq was launched in April 2020 as a national initiative to integrate whole genome sequencing data from 10,000 Canadians infected with SARS-CoV-2 with clinical information related to their disease experience. The mandate of HostSeq is to support the Canadian and international research communities in their efforts to understand the risk factors for disease and associated health outcomes and support the development of interventions such as vaccines and therapeutics. HostSeq is a collaboration among 13 independent epidemiological studies of SARS-CoV-2 across five provinces in Canada. Aggregated data collected by HostSeq are made available to the public through two data portals: a phenotype portal showing summaries of major variables and their distributions, and a variant search portal enabling queries in a genomic region. Individual-level data is available to the global research community for health research through a Data Access Agreement and Data Access Compliance Office approval. Here we provide an overview of the collective project design along with summary level information for HostSeq. We highlight several statistical considerations for researchers using the HostSeq platform regarding data aggregation, sampling mechanism, covariate adjustment, and X chromosome analysis. In addition to serving as a rich data source, the diversity of study designs, sample sizes, and research objectives among the participating studies provides unique opportunities for the research community.
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Affiliation(s)
- S Yoo
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - E Garg
- Simon Fraser University, Burnaby, BC, Canada
| | - L T Elliott
- Simon Fraser University, Burnaby, BC, Canada
| | - R J Hung
- University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - A R Halevy
- The Hospital for Sick Children, Toronto, ON, Canada
| | - J D Brooks
- University of Toronto, Toronto, ON, Canada
| | - S B Bull
- University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - F Gagnon
- University of Toronto, Toronto, ON, Canada
| | - Cmt Greenwood
- McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - J F Lawless
- University of Waterloo, Waterloo, ON, Canada
| | - A D Paterson
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - L Sun
- University of Toronto, Toronto, ON, Canada
| | | | - J Lerner-Ellis
- University of Toronto, Toronto, ON, Canada
- Sinai Health System, Toronto, ON, Canada
| | - Rjs Abraham
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - I Birol
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - G Bourque
- McGill University, Montreal, QC, Canada
| | - J-M Garant
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - C Gosselin
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - J Li
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - J Whitney
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - J-A Herbrick
- The Hospital for Sick Children, Toronto, ON, Canada
| | - M Lorenti
- The Hospital for Sick Children, Toronto, ON, Canada
| | - M S Reuter
- The Hospital for Sick Children, Toronto, ON, Canada
| | - O O Adeoye
- The Hospital for Sick Children, Toronto, ON, Canada
| | - S Liu
- The Hospital for Sick Children, Toronto, ON, Canada
| | - U Allen
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - F P Bernier
- University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital, Calgary, AB, Canada
| | - C M Biggs
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
| | - A M Cheung
- University Health Network, Toronto, ON, Canada
| | - J Cowan
- University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Herridge
- University Health Network, Toronto, ON, Canada
| | | | - B P Modi
- BC Children's Hospital, Vancouver, BC, Canada
| | - V Mooser
- McGill University, Montreal, QC, Canada
| | - S K Morris
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - M Ostrowski
- University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - R S Parekh
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - G Pfeffer
- University of Calgary, Calgary, AB, Canada
| | | | - J Taher
- University of Toronto, Toronto, ON, Canada
- Sinai Health System, Toronto, ON, Canada
| | - J Upton
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - R L Warren
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - Rsm Yeung
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - N Aziz
- The Hospital for Sick Children, Toronto, ON, Canada
| | - S E Turvey
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
| | | | - M Lathrop
- McGill University, Montreal, QC, Canada
| | - Sjm Jones
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - S W Scherer
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - L J Strug
- The Hospital for Sick Children, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
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16
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Campigotto A, Chris A, Orkin J, Lau L, Marshall C, Bitnun A, Buchan SA, MacDonald L, Thampi N, McCready J, Juni P, Parekh RS, Science M. Utility of SARS-CoV-2 Genomic Sequencing for Understanding Transmission and School Outbreaks. Pediatr Infect Dis J 2023; 42:324-331. [PMID: 36795555 PMCID: PMC9990487 DOI: 10.1097/inf.0000000000003834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVE An understanding of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission in schools is important. It is often difficult, using epidemiological information alone, to determine whether cases associated with schools represent multiple introductions from the community or transmission within the school. We describe the use of whole genome sequencing (WGS) in multiple schools to investigate outbreaks of SARS-CoV-2 in the pre-Omicron period. STUDY DESIGN School outbreaks were identified for sequencing by local public health units based on multiple cases without known epidemiological links. Cases of SARS-CoV-2 from students and staff from 4 school outbreaks in Ontario underwent WGS and phylogenetic analysis. The epidemiological clinical cohort data and genomic cluster data are described to help further characterize these outbreaks. RESULTS A total of 132 positive SARS-CoV-2 cases among students and staff from 4 school outbreaks were identified with 65 (49%) of cases able to be sequenced with high-quality genomic data. The 4 school outbreaks consisted of 53, 37, 21 and 21 positive cases; within each outbreak there were between 8 and 28 different clinical cohorts identified. Among the sequenced cases, between 3 and 7 genetic clusters, defined as different strains, were identified in each outbreak. We found genetically different viruses within several clinical cohorts. CONCLUSIONS WGS, together with public health investigation, is a useful tool to investigate SARS-CoV-2 transmission within schools. Its early use has the potential to better understand when transmission may have occurred, can aid in evaluating how well mitigation interventions are working and has the potential to reduce unnecessary school closures when multiple genetic clusters are identified.
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Affiliation(s)
- Aaron Campigotto
- From the Division of Microbiology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children
- Department of Laboratory Medicine and Pathobiology, University of Toronto
| | | | | | - Lynette Lau
- Division of Genome Diagnostics, Department of Paediatric Laboratory Medicine
| | - Christian Marshall
- Department of Laboratory Medicine and Pathobiology, University of Toronto
- Division of Genome Diagnostics, Department of Paediatric Laboratory Medicine
| | - Ari Bitnun
- Department of Paediatrics
- Division of Infectious Diseases, The Hospital for Sick Children
| | - Sarah A Buchan
- Public Health Ontario
- Dalla Lana School of Public Health, University of Toronto
| | | | - Nisha Thampi
- Department of Paediatrics, Children’s Hospital of Eastern Ontario
| | - Janine McCready
- Division of Infectious Diseases, Department of Medicine, Michael Garron Hospital
| | - Peter Juni
- St. Michael’s Hospital, Applied Health Research Centre, Li Ka Shing Knowledge Institute, University of Toronto
| | - Rulan S Parekh
- Department of Medicine, Women’s College Hospital, Toronto, ON, Canada
| | - Michelle Science
- Division of Infectious Diseases, The Hospital for Sick Children
- Public Health Ontario
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17
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Chan EYH, Yap DYH, Colucci M, Ma ALT, Parekh RS, Tullus K. Use of Rituximab in Childhood Idiopathic Nephrotic Syndrome. Clin J Am Soc Nephrol 2023; 18:533-548. [PMID: 36456193 PMCID: PMC10103321 DOI: 10.2215/cjn.08570722] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 12/04/2022]
Abstract
Rituximab is an established therapy in children with idiopathic nephrotic syndrome to sustain short- to medium-term disease remission and avoid steroid toxicities. Recent trials focus on its use as a first-line agent among those with milder disease severity. Rituximab is used in multidrug refractory nephrotic syndrome and post-transplant disease recurrence, although the evidence is much less substantial. Available data suggest that the treatment response to rituximab depends on various patient factors, dosing regimen, and the concomitant use of maintenance immunosuppression. After repeated treatments, patients are found to have an improving response overall with a longer relapse-free period. The drug effect, however, is not permanent, and 80% of patients eventually relapse and many will require an additional course of rituximab. This underpins the importance of understanding the long-term safety profile on repeated treatments. Although rituximab appears to be generally safe, there are concerns about long-term hypogammaglobulinemia, especially in young children. Reliable immunophenotyping and biomarkers are yet to be discovered to predict treatment success, risk of both rare and severe side effects, e.g. , persistent hypogammaglobulinemia, and guiding of redosing strategy. In this review, we highlight recent advances in the use of rituximab for childhood nephrotic syndrome and how the therapeutic landscape is evolving.
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Affiliation(s)
- Eugene Yu-hin Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon, Hong Kong
- Department of Paediatric and Adolescent Medicine, Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Desmond Yat-hin Yap
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Manuela Colucci
- Renal Diseases Research Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alison Lap-tak Ma
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon, Hong Kong
- Department of Paediatric and Adolescent Medicine, Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Rulan S. Parekh
- Departments of Medicine and Pediatrics, Women's College Hospital, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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18
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Ilori TO, Solarin A, Manmak M, Raji YR, Braimoh R, Kwakyi E, Umeizudike T, Ajepe T, Bolanle O, Ripiye N, Eduful E, Adebile T, Ijeoma C, Mumuni AA, Chern J, Akinpelu M, Ulasi I, Arogundade F, Salako BL, Gbadegesin R, Parekh RS, Dupuis J, Amira CO, Adu D, Anderson CA, Ojo A, Waikar SS. Rationale and Design of the Diet, CKD, and Apolipoprotein L1 Study in Low-Income and Middle-Income Countries. Kidney Int Rep 2023; 8:764-774. [PMID: 37069986 PMCID: PMC10105057 DOI: 10.1016/j.ekir.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Diet, chronic kidney disease (CKD), and Apolipoprotein L1 (APOL1) (DCA) Study is examining the role of dietary factors in CKD progression and APOL1 nephropathy. We describe enrollment and retention efforts and highlight facilitators and barriers to enrollment and operational challenges, as well as accommodations made in the study protocol. Methods The DCA study is enrolling participants in 7 centers in West Africa. Participants who consented were invited to complete dietary recalls and 24-hour urine collections in year 1. We conducted focus groups and semistructured interviews among study personnel to identify facilitators and barriers to enrollment as well as retention and operational challenges in the execution of the study protocol. We analyzed emerging themes using content analyses. Results A total of 712 participants were enrolled in 18 months with 1256 24-hour urine and 1260 dietary recalls. Barriers to enrollment were the following: (i) a lack of understanding of research, (ii) the burden of research visits, and (iii) incorporating cultural and traditional nuances when designing research protocols. Factors facilitating enrollment were the following: (i) designing convenient research visits, (ii) building rapport and increased communication between the research team and participants, and (iii) cultural sensitivity - adapting research protocols for the populations involved. Offering home visits, providing free dietary counseling, reducing the volume of study blood collection, and reducing the frequency of visits were some changes made in the study protocol that increased participant satisfaction. Conclusion Adopting a participant-centered approach with accommodations in the protocol for cultural adaptability and incorporating participant feedback is vital for carrying out research in low-income and middle-income regions.
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Affiliation(s)
- Titilayo O. Ilori
- Division of Nephrology, Department of Medicine, Boston Medical Center, Boston University School of Medicine Boston, Massachusetts, USA
| | - Adaobi Solarin
- Department of Pediatrics and Child Health, College of Medicine, Lagos State University, Nigeria
| | - Mamven Manmak
- Department of Internal Medicine, University of Abuja, Nigeria
| | - Yemi R. Raji
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rotimi Braimoh
- Department of Medicine, College of Medicine, University of Lagos, Nigeria
| | - Edward Kwakyi
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Ghana
| | | | - Titilope Ajepe
- Department of Physiotherapy, College of Medicine, University of Lagos, Nigeria
| | - Omotoso Bolanle
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Nanna Ripiye
- Department of Internal Medicine, University of Abuja, Nigeria
| | - Ernestina Eduful
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Ghana
| | - Temitayo Adebile
- Division of Nephrology, Department of Medicine, Boston Medical Center, Boston University School of Medicine Boston, Massachusetts, USA
| | | | - Amisu A. Mumuni
- Department of Medicine, College of Medicine, Lagos State University, Nigeria
| | - Jessica Chern
- Division of Nephrology, Department of Medicine, Boston Medical Center, Boston University School of Medicine Boston, Massachusetts, USA
| | - Morenikeji Akinpelu
- Division of Nephrology, Department of Medicine, Boston Medical Center, Boston University School of Medicine Boston, Massachusetts, USA
| | | | - Fatiu Arogundade
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Babatunde L. Salako
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rasheed Gbadegesin
- Department of Pediatrics, Department of Medicine, Duke University School of Medicine, North Carolina, USA
| | - Rulan S. Parekh
- Department of Medicine, Women’s College Hospital, Hospital for Sick Children and University of Toronto, Ontario, Canada
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Dwomoa Adu
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Ghana
| | - Cheryl A.M. Anderson
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Akinlolu Ojo
- Department of Medicine, Kansas University Medical Center, The University of Kansas, Kansas, USA
| | - Sushrut S. Waikar
- Division of Nephrology, Department of Medicine, Boston Medical Center, Boston University School of Medicine Boston, Massachusetts, USA
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19
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Kallash M, Wang Y, Smith A, Trachtman H, Gbadegesin R, Nester C, Canetta P, Wang C, Hunley TE, Sperati CJ, Selewski D, Ayoub I, Srivastava T, Mottl AK, Kopp J, Gillespie B, Robinson B, Chen D, Steinke J, Twombley K, Reidy K, Mucha K, Greenbaum LA, Blazius B, Helmuth M, Yonatan P, Parekh RS, Hogan S, Royal V, D'Agati V, Chishti A, Falk R, Gharavi A, Holzman L, Klein J, Smoyer W, Kretzler M, Gipson D, Kidd JM. Rapid Progression of Focal Segmental Glomerulosclerosis in Patients with High-Risk APOL1 Genotypes. Clin J Am Soc Nephrol 2023; 18:344-355. [PMID: 36763813 PMCID: PMC10103277 DOI: 10.2215/cjn.0000000000000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND FSGS is a heterogeneous diagnosis with a guarded prognosis. Polymorphisms in the apolipoprotein L1 ( APOL1 ) gene are associated with developing FSGS and faster progression to kidney failure in affected patients. Better understanding the natural history of patients with FSGS and APOL1 risk alleles is essential to improve patient care and support the design and interpretation of interventional studies. The objective of this study was to evaluate the quantitative association between APOL1 and kidney disease progression and the interaction with other clinical and laboratory factors. METHODS CureGN cohort study participants with biopsy diagnosis of FSGS, regardless of self-identified race, were included. The exposure of interest was two APOL1 risk alleles (high risk) versus zero to one risk alleles (low risk). The primary outcome was eGFR slope categorized as rapid progressor (eGFR slope ≤-5 ml/min per year), intermediate progressor (slope between 0 and -5), or nonprogressor (slope ≥0). Multivariable ordinal logistic and linear regressions were used for adjusted analyses. Missing data were addressed using multiple imputation. RESULTS Of 650 participants, 476 (73%) had genetic testing, among whom 87 (18%) were high risk. High-risk participants were more likely to have lower median eGFR (62 [interquartile range, 36-81] versus low-risk participants 76 ml/min per 1.73 m 2 [interquartile range, 44-106]; P <0.01). In adjusted analysis, the odds of more rapid progression of eGFR was 2.75 times higher (95% confidence interval, 1.67 to 4.53; P <0.001) in the high-risk versus low-risk groups. CONCLUSIONS In patients with FSGS, high-risk APOL1 genotype is the predominant factor associated with more rapid loss of kidney function.
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Affiliation(s)
- Mahmoud Kallash
- Division of Pediatric Nephrology, Nationwide Children's Hospital, Columbus, Ohio
| | - Yujie Wang
- University of Michigan, Ann Arbor, Michigan
| | - Abigail Smith
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Howard Trachtman
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Rasheed Gbadegesin
- Department of Pediatric Nephrology, Duke Children's Hospital and Health Center, Durham, North Carolina
| | - Carla Nester
- Division of Pediatric Nephrology, Dialysis and Transplantation, Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | - Pietro Canetta
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Chen Wang
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Tracy E. Hunley
- Division of Pediatric Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - C. John Sperati
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Selewski
- Department of Pediatric Nephrology, Medical University of South Carolina, Charleston, South Carolina
| | - Isabelle Ayoub
- Department of Medicine, Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Tarak Srivastava
- Children's Mercy Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Amy K. Mottl
- Division of Nephrology and Hypertension, Kidney Center, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jeffrey Kopp
- Kidney Disease Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Brenda Gillespie
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Dhruti Chen
- Division of Nephrology and Hypertension, Kidney Center, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Julia Steinke
- Division of Medical Subspecialties, Section of Pediatric Nephrology, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Katherine Twombley
- Department of Pediatric Nephrology, Medical University of South Carolina, Charleston, South Carolina
| | - Kimberly Reidy
- Department of Pediatric Nephrology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Krzysztof Mucha
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Larry A. Greenbaum
- Division of Pediatric Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Brooke Blazius
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | | | - Peleg Yonatan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Rulan S. Parekh
- Division of Pediatric Nephrology, Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medicine, Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Susan Hogan
- Division of Nephrology and Hypertension, Kidney Center, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Virginie Royal
- Division of Pathology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Vivette D'Agati
- Department of Pathology, Columbia University Medical Center, New York, New York
| | - Aftab Chishti
- Division of Nephrology, Hypertension and Renal Transplantation, University of Kentucky, Lexington, Kentucky
| | - Ronald Falk
- Division of Nephrology and Hypertension, Kidney Center, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Ali Gharavi
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Lawrence Holzman
- Department of Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Jon Klein
- Department of Medicine-Renal, University of Louisville School of Medicine, Louisville, Kentucky
| | - William Smoyer
- Division of Pediatric Nephrology, Nationwide Children's Hospital, Columbus, Ohio
| | - Matthias Kretzler
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Debbie Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Jason M. Kidd
- Division of Nephrology, Virginia Commonwealth University, Richmond, Virginia
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20
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Krissberg JR, O'Shaughnessy MM, Smith AR, Helmuth ME, Almaani S, Aviles DH, Brathwaite KE, Cai Y, Cattran D, Gbadegesin R, Glenn DA, Greenbaum LA, Iragorri S, Jain K, Khalid M, Kidd J, Kopp J, Lafayette R, Lane JC, Lugani F, Nestor JG, Parekh RS, Reidy K, Selewski DT, Sethna CB, Sperati CJ, Tuttle K, Twombley K, Vasylyeva TL, Weaver DJ, Wenderfer SE, Gibson K. Racial and Ethnic Disparities in Acute Care Utilization Among Patients With Glomerular Disease. Am J Kidney Dis 2023; 81:318-328.e1. [PMID: 36191724 PMCID: PMC9974571 DOI: 10.1053/j.ajkd.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/03/2022] [Indexed: 01/25/2023]
Abstract
RATIONALE & OBJECTIVE The effects of race, ethnicity, socioeconomic status (SES), and disease severity on acute care utilization in patients with glomerular disease are unknown. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 1,456 adults and 768 children with biopsy-proven glomerular disease enrolled in the Cure Glomerulonephropathy (CureGN) cohort. EXPOSURE Race and ethnicity as a participant-reported social factor. OUTCOME Acute care utilization defined as hospitalizations or emergency department visits. ANALYTICAL APPROACH Multivariable recurrent event proportional rate models were used to estimate associations between race and ethnicity and acute care utilization. RESULTS Black or Hispanic participants had lower SES and more severe glomerular disease than White or Asian participants. Acute care utilization rates were 45.6, 29.5, 25.8, and 19.2 per 100 person-years in Black, Hispanic, White, and Asian adults, respectively, and 55.8, 42.5, 40.8, and 13.0, respectively, for children. Compared with the White race (reference group), Black race was significantly associated with acute care utilization in adults (rate ratio [RR], 1.76 [95% CI, 1.37-2.27]), although this finding was attenuated after multivariable adjustment (RR, 1.31 [95% CI, 1.03-1.68]). Black race was not significantly associated with acute care utilization in children; Asian race was significantly associated with lower acute care utilization in children (RR, 0.32 [95% CI 0.14-0.70]); no significant associations between Hispanic ethnicity and acute care utilization were identified. LIMITATIONS We used proxies for SES and lacked direct information on income, household unemployment, or disability. CONCLUSIONS Significant differences in acute care utilization rates were observed across racial and ethnic groups in persons with prevalent glomerular disease, although many of these difference were explained by differences in SES and disease severity. Measures to combat socioeconomic disadvantage in Black patients and to more effectively prevent and treat glomerular disease are needed to reduce disparities in acute care utilization, improve patient wellbeing, and reduce health care costs.
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Affiliation(s)
- Jill R Krissberg
- Division of Pediatric Nephrology, Anne & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Michelle M O'Shaughnessy
- Department of Renal Medicine, Cork University Hospital, Ireland; and School of Medicine, University College Cork, Ireland
| | - Abigail R Smith
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - Salem Almaani
- Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Diego H Aviles
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Kaye E Brathwaite
- Division of Pediatric/Nephrology, Children's Hospital at Montefiore/Einstein, Bronx, New York
| | - Yi Cai
- Pediatric Nephrology, Dialysis and Transplantation, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Daniel Cattran
- Division of Nephrology, University Health Network, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Rasheed Gbadegesin
- Department of Pediatrics, Division of Nephrology, Duke University Medical Center, Durham, North Carolina
| | - Dorey A Glenn
- Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Larry A Greenbaum
- Division of Pediatric Nephrology, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - Koyal Jain
- Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Myda Khalid
- Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jason Kidd
- Virginia Commonwealth University, Richmond, Virginia
| | - Jeffrey Kopp
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Richard Lafayette
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Jerome C Lane
- Division of Pediatric Nephrology, Anne & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Francesca Lugani
- L'Unità Operativa Complessa Nefrology, Dialysis and Transplant, Laboratorio di Nefrologia Molecolare, Istituto Giannina Gaslini Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Jordan G Nestor
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Rulan S Parekh
- Division of Nephrology, Department of Pediatrics and Medicine, Hospital for Sick Children, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Kimberly Reidy
- Division of Pediatric/Nephrology, Children's Hospital at Montefiore/Einstein, Bronx, New York
| | - David T Selewski
- Department of Pediatrics, Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina
| | - Christine B Sethna
- Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, New York
| | - C John Sperati
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine Tuttle
- Providence Health Care, Department of Medicine, Division of Nephrology, University of Washington, Spokane and Seattle, Washington
| | - Katherine Twombley
- Department of Pediatrics, Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina
| | - Tetyana L Vasylyeva
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas
| | - Donald J Weaver
- Division of Pediatric Nephrology and Hypertension, Atrium Health Levine Children's, Charlotte, North Carolina
| | - Scott E Wenderfer
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Keisha Gibson
- Department of Medicine and Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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21
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Olanrewaju TO, Osafo C, Raji YR, Mamven M, Ajayi S, Ilori TO, Arogundade FA, Ulasi II, Gbadegesin R, Parekh RS, Tayo B, Adeyemo AA, Adedoyin OT, Chijioke AA, Bewaji C, Grobbee DE, Blankestijn PJ, Klipstein-Grobusch K, Salako BL, Adu D, Ojo AO. Cardiovascular Risk Factor Burden and Association With CKD in Ghana and Nigeria. Kidney Int Rep 2023; 8:658-666. [PMID: 36938080 PMCID: PMC10014339 DOI: 10.1016/j.ekir.2022.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD); however, the burden of cardiovascular risk factors in patients with CKD in Africa is not well characterized. We determined the prevalence of selected cardiovascular risk factors, and association with CKD in the Human Heredity for Health in Africa Kidney Disease Research Network study. Methods We recruited patients with and without CKD in Ghana and Nigeria. CKD was defined as estimated glomerular filtration rate of <60 ml/min per 1.73 m2 and/or albuminuria as albumin-to-creatinine ratio <3.0 mg/mmol (<30 mg/g) for ≥3 months. We assessed self-reported (physician-diagnosis and/or use of medication) hypertension, diabetes, and elevated cholesterol; and self-reported smoking as cardiovascular risk factors. Association between the risk factors and CKD was determined by multivariate logistic regression. Results We enrolled 8396 participants (cases with CKD, 3956), with 56% females. The mean age (45.5 ± 15.1 years) did not differ between patients and control group. The prevalence of hypertension (59%), diabetes (20%), and elevated cholesterol (9.9%), was higher in CKD patients than in the control participants (P < 0.001). Prevalence of risk factors was higher in Ghana than in Nigeria. Hypertension (adjusted odds ratio [aOR] = 1.69 [1.43-2.01, P < 0.001]), elevated cholesterol (aOR = 2.0 [1.39-2.86, P < 0.001]), age >50 years, and body mass index (BMI) <18.5 kg/m2 were independently associated with CKD. The association of diabetes and smoking with CKD was modified by other risk factors. Conclusion Cardiovascular risk factors are prevalent in middle-aged adult patients with CKD in Ghana and Nigeria, with higher proportions in Ghana than in Nigeria. Hypertension, elevated cholesterol, and underweight were independently associated with CKD.
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Affiliation(s)
- Timothy O. Olanrewaju
- Division of Nephrology, Department of Medicine, University of Ilorin, Ilorin, Nigeria
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Charlotte Osafo
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Ghana
| | - Yemi R. Raji
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Manmak Mamven
- Department of Medicine, University of Abuja, Abuja, Nigeria
| | - Samuel Ajayi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Titilayo O. Ilori
- Section of Nephrology, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Ifeoma I. Ulasi
- Department of Medicine, College of Health Sciences, University of Nigeria, Enugu, Nigeria
| | - Rasheed Gbadegesin
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Rulan S. Parekh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Bamidele Tayo
- Department of Public Health Sciences, Loyola University Parkinson School of Health Sciences and Public Health, Maywood, Illinois, USA
| | - Adebowale A. Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Adindu A. Chijioke
- Division of Nephrology, Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Clement Bewaji
- Department of Biochemistry, University of Ilorin, Ilorin, Nigeria
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter J. Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Dwomoa Adu
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Ghana
| | - Akinlolu O. Ojo
- University of Kansas School of Medicine, Kansas City, Kansas, USA
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22
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Chung J, Robinson CH, Yu A, Bamhraz AA, Ewusie JE, Sanger S, Mitsnefes M, Parekh RS, Raina R, Thabane L, Dionne JM, Chanchlani R. Risk of Target Organ Damage in Children With Primary Ambulatory Hypertension: A Systematic Review and Meta-Analysis. Hypertension 2023; 80:1183-1196. [PMID: 36802759 DOI: 10.1161/hypertensionaha.122.20190] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Target organ damage (TOD) such as left ventricular hypertrophy (LVH), abnormal pulse wave velocity, and elevated carotid intima-media thickness are common among adults with hypertension and are associated with overt cardiovascular events. The risk of TOD among children and adolescents with hypertension confirmed by ambulatory blood pressure monitoring is poorly understood. In this systematic review, we compare the risks of TOD among children and adolescents with ambulatory hypertension to normotensive individuals. METHODS A literature search was conducted to include all relevant English-language publications from January 1974 to March 2021. Studies were included if patients underwent 24-hour ambulatory blood pressure monitoring and ≥1 TOD was reported. Ambulatory hypertension was defined by society guidelines. Primary outcome was the risk of TOD, including LVH, left ventricular mass index, pulse wave velocity, and carotid intima-media thickness among children with ambulatory hypertension compared with those with ambulatory normotension. Meta-regression calculated the effect of body mass index on TOD. RESULTS Of 12 252 studies, 38 (n=3609 individuals) were included for analysis. Children with ambulatory hypertension had an increased risk of LVH (odds ratio, 4.69 [95% CI, 2.69-8.19]), elevated left ventricular mass index (pooled difference, 5.13 g/m2.7; [95% CI, 3.78-6.49]), elevated pulse wave velocity (pooled difference, 0.39 m/s [95% CI, 0.20-0.58]), and elevated carotid intima-media thickness (pooled difference, 0.04 mm [95% CI, 0.02-0.05]), compared with normotensive children. Meta-regression showed a significant positive effect of body mass index on left ventricular mass index and carotid intima-media thickness. CONCLUSIONS Children with ambulatory hypertension have adverse TOD profiles, which may increase their risk for future cardiovascular disease. This review highlights the importance of optimizing blood pressure control and screening for TOD in children with ambulatory hypertension. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42020189359.
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Affiliation(s)
- Jason Chung
- University of Toronto, Temerty Faculty of Medicine, Ontario, Canada (J.C.)
| | - Cal H Robinson
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada (C.H.R., A.A.B., R.S.P.)
| | - Andrew Yu
- University of Alberta, Faculty of Science, Edmonton, Canada (A.Y.)
| | - Abdulaziz A Bamhraz
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada (C.H.R., A.A.B., R.S.P.)
| | - Joycelyne E Ewusie
- Research Institute - St Joseph's Healthcare Hamilton, Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada. (J.E.E., L.T.)
| | - Stephanie Sanger
- Department of Health Sciences, McMaster University, Ontario, Canada. (S.S.)
| | - Mark Mitsnefes
- Division of Nephrology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (M.M.)
| | - Rulan S Parekh
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada (C.H.R., A.A.B., R.S.P.)
| | - Rupesh Raina
- Division of Pediatric Nephrology, Department of Pediatrics, Akron Children's Hospital, OH (R.R.)
| | - Lehana Thabane
- Research Institute - St Joseph's Healthcare Hamilton, Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada. (J.E.E., L.T.).,University of Johannesburg Faculty of Health Sciences, South Africa (L.T.)
| | - Janis M Dionne
- Division of Nephrology, Department of Pediatrics, BC Children's Hospital, Vancouver, Canada (J.M.D.)
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Canada (R.C.)
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23
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Chen DP, Helmuth ME, Smith AR, Canetta PA, Ayoub I, Mucha K, Kallash M, Kopp JB, Gbadegesin R, Gillespie BW, Greenbaum LA, Parekh RS, Hunley TE, Sperati CJ, Selewski DT, Kidd J, Chishti A, Reidy K, Mottl AK, Gipson DS, Srivastava T, Twombley KE. Age of Onset and Disease Course in Biopsy-Proven Minimal Change Disease: An Analysis From the Cure Glomerulonephropathy Network. Am J Kidney Dis 2023; 81:695-706.e1. [PMID: 36608921 DOI: 10.1053/j.ajkd.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/19/2022] [Indexed: 01/05/2023]
Abstract
RATIONALE & OBJECTIVE Adolescent- and adult-onset minimal change disease (MCD) may have a clinical course distinct from childhood-onset disease. We characterized the course of children and adults with MCD in the Cure Glomerulonephropathy Network (CureGN) and assessed predictors of rituximab response. STUDY DESIGN Prospective, multicenter, observational study. STUDY PARTICIPANTS CureGN participants with proven MCD on biopsy. EXPOSURE Age at disease onset, initiation of renin-angiotensin-aldosterone system (RAAS) blockade, and immunosuppression including rituximab during the study period. OUTCOME Relapse and remission, change in estimated glomerular filtration rate (eGFR), and kidney failure. ANALYTICAL APPROACH Remission and relapse probabilities were estimated using Kaplan-Meier curves and gap time recurrent event models. Linear regression models were used for the outcome of change in eGFR. Cox proportional hazards models were used to estimate the association between rituximab administration and remission. RESULTS The study included 304 childhood- (≤12 years old), 49 adolescent- (13-17 years old), and 201 adult- (≥18 years) onset participants with 2.7-3.2 years of follow-up after enrollment. Children had a longer time to biopsy (238 vs 23 and 36 days in adolescent- and adult-onset participants, respectively; P<0.001) and were more likely to have received therapy before biopsy. Children were more likely to be treated with immunosuppression but not RAAS blockade. The rate of relapse was higher in childhood- versus adult-onset participants (HR, 1.69 [95% CI, 1.29-2.21]). The probability of remission was also higher in childhood-onset disease (HR, 1.33 [95%CI, 1.02-1.72]). In all groups eGFR loss was minimal. Children were more likely to remit after rituximab than those with adolescent- or adult-onset disease (adjusted HR, 2.1; P=0.003). Across all groups, glucocorticoid sensitivity was associated with a greater likelihood of achieving complete remission after rituximab (adjusted HR, 2.62; P=0.002). LIMITATIONS CureGN was limited to biopsy-proven disease. Comparisons of childhood to nonchildhood cases of MCD may be subject to selection bias, given that childhood cases who undergo a biopsy may be limited to patients who are least responsive to initial therapy. CONCLUSIONS Among patients with MCD who underwent kidney biopsy, there were differences in the course (relapse and remission) of childhood-onset compared with adolescent- and adult-onset disease, as well as rituximab response.
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Affiliation(s)
- Dhruti P Chen
- University of North Carolina, Chapel Hill, and Duke Children's Hospital Medical Center, Durham, North Carolina.
| | - Margaret E Helmuth
- Arbor Research Collaborative for Health, and University of Michigan, Ann Arbor, Michigan
| | - Abigail R Smith
- Arbor Research Collaborative for Health, and University of Michigan, Ann Arbor, Michigan
| | - Pietro A Canetta
- Division of Nephrology, Department of Medicine, and Irving Medical Center, Columbia University, New York, and Montefiore Medical Center, Bronx, New York
| | - Isabelle Ayoub
- Division of Nephrology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Krzysztof Mucha
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Mahmoud Kallash
- Division of Nephrology, Wexner Medical Center, The Ohio State University, Columbus, Ohio; Division of Nephrology, Nationwide Children's Hospital, Columbus, Ohio
| | - Jeffrey B Kopp
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Baltimore, Maryland
| | - Rasheed Gbadegesin
- University of North Carolina, Chapel Hill, and Duke Children's Hospital Medical Center, Durham, North Carolina
| | - Brenda W Gillespie
- Arbor Research Collaborative for Health, and University of Michigan, Ann Arbor, Michigan
| | - Larry A Greenbaum
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Rulan S Parekh
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - David T Selewski
- Medical University of South Carolina, Charleston, South Carolina
| | - Jason Kidd
- Virginia Commonwealth University, Richmond, Virginia
| | | | - Kimberly Reidy
- Division of Nephrology, Department of Medicine, and Irving Medical Center, Columbia University, New York, and Montefiore Medical Center, Bronx, New York
| | - Amy K Mottl
- University of North Carolina, Chapel Hill, and Duke Children's Hospital Medical Center, Durham, North Carolina
| | - Debbie S Gipson
- Arbor Research Collaborative for Health, and University of Michigan, Ann Arbor, Michigan
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24
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Robinson CH, Klowak JA, Jeyakumar N, Luo B, Wald R, Garg AX, Nash DM, McArthur E, Greenberg JH, Askenazi D, Mammen C, Thabane L, Goldstein S, Silver SA, Parekh RS, Zappitelli M, Chanchlani R. Long-term Health Care Utilization and Associated Costs After Dialysis-Treated Acute Kidney Injury in Children. Am J Kidney Dis 2023; 81:79-89.e1. [PMID: 35985371 DOI: 10.1053/j.ajkd.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 07/10/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE & OBJECTIVE Acute kidney injury (AKI) is common among hospitalized children and is associated with increased hospital length of stay and costs. However, there are limited data on postdischarge health care utilization after AKI hospitalization. Our objectives were to evaluate health care utilization and physician follow-up patterns after dialysis-treated AKI in a pediatric population. STUDY DESIGN Retrospective cohort study, using provincial health administrative databases. SETTING & PARTICIPANTS All children (0-18 years) hospitalized between 1996 and 2017 in Ontario, Canada. Excluded individuals comprised non-Ontario residents; those with metabolic disorders or poisoning; and those who received dialysis or kidney transplant before admission, a kidney transplant by 104 days after discharge, or were receiving dialysis 76-104 days from dialysis start date. EXPOSURE Episodes of dialysis-treated AKI, identified using validated health administrative codes. AKI survivors were matched to 4 hospitalized controls without dialysis-treated AKI by age, sex, and admission year. OUTCOME Our primary outcome was postdischarge hospitalizations, emergency department visits, and outpatient physician visits. Secondary outcomes included outpatient visits by physician type and composite health care costs. ANALYTICAL APPROACH Proportions with≥1 event and rates (per 1,000 person-years). Total and median composite health care costs. Adjusted rate ratios using negative binomial regression models. RESULTS We included 1,688 pediatric dialysis-treated AKI survivors and 6,752 matched controls. Dialysis-treated AKI survivors had higher rehospitalization and emergency department visit rates during the analyzed follow-up periods (0-1, 0-5, and 0-10 years postdischarge, and throughout follow-up), and higher outpatient visit rates in the 0-1-year follow-up period. The overall adjusted rate ratio for rehospitalization was 1.46 (95% CI, 1.25-1.69; P<0.0001) and for outpatient visits was 1.16 (95% CI, 1.09-1.23; P=0.01). Dialysis-treated AKI survivors also had higher health care costs. Nephrologist follow-up was infrequent among dialysis-treated AKI survivors (18.6% by 1 year postdischarge). LIMITATIONS Potential miscoding of study exposures or outcomes. Residual uncontrolled confounding. Data for health care costs and emergency department visits was unavailable before 2006 and 2001, respectively. CONCLUSIONS Dialysis-treated AKI survivors had greater postdischarge health care utilization and costs versus hospitalized controls. Strategies are needed to improve follow-up care for children after dialysis-treated AKI to prevent long-term complications.
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Affiliation(s)
- Cal H Robinson
- Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Ontario, Canada
| | | | | | | | - Ron Wald
- Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Jason H Greenberg
- Division of Nephrology, Department of Pediatrics, Yale University, New Haven, Connecticut
| | - David Askenazi
- Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama, Birmingham, Alabama
| | - Cherry Mammen
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Vancouver, British Colombia, Canada
| | - Lehana Thabane
- Department of Pediatrics, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Stuart Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital, Ohio
| | - Samuel A Silver
- Division of Nephrology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Rulan S Parekh
- Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Zappitelli
- Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, Ontario, Canada; ICES, Ontario, Canada.
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25
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Osafo C, Thomford NE, Coleman J, Carboo A, Guure C, Okyere P, Adu D, Adanu R, Parekh RS, Burke D. APOL1 genotype associated risk for preeclampsia in African populations: Rationale and protocol design for studies in women of African ancestry in resource limited settings. PLoS One 2022; 17:e0278115. [PMID: 36580463 PMCID: PMC9799323 DOI: 10.1371/journal.pone.0278115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/09/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Women of African ancestry are highly predisposed to preeclampsia which continues to be a major cause of maternal death in Africa. Common variants in the APOL1 gene are potent risk factor for a spectrum of kidney disease. Recent studies have shown that APOL1 risk variants contribute to the risk of preeclampsia. The aim of the study is to understand the contribution of APOL1 risk variants to the development of preeclampsia in pregnant women in Ghana. METHODS The study is a case-control design which started recruitment in 2019 at the Korle Bu Teaching Hospital in Ghana. The study will recruit pregnant women with a target recruitment of 700 cases of preeclampsia and 700 normotensives. Clinical and demographic data of mother- baby dyad, with biospecimens including cord blood and placenta will be collected to assess clinical, biochemical and genetic markers of preeclampsia. The study protocol was approved by Korle Bu Teaching Hospital Institutional Review Board (Reference number: KBTH-IRB/000108/2018) on October 11, 2018. PRELIMINARY RESULTS As of December 2021, a total of 773 mother-baby pairs had been recruited and majority of them had complete entry of data for analysis. The participants are made up of 384 preeclampsia cases and 389 normotensive mother-baby dyad. The mean age of participants is 30.69 ± 0.32 years for cases and 29.95 ± 0.32 for controls. Majority (85%) of the participants are between 20-30years. At booking, majority of cases had normal blood pressure compared to the time of diagnosis where 85% had a systolic BP greater than 140mmHg and a corresponding 82% had diastolic pressure greater than 90mmHg. CONCLUSION Our study will ultimately provide clinical, biochemical and genotypic data for risk stratification of preeclampsia and careful monitoring during pregnancy to improve clinical management and outcomes.
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Affiliation(s)
- Charlotte Osafo
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
- The Bank Hospital, Cantonment, Accra, Ghana
| | - Nicholas Ekow Thomford
- Pharmacogenomics and Genomic Medicine Group, Department of Medical Biochemistry, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jerry Coleman
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Abraham Carboo
- School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Chris Guure
- School of Medical Sciences, KNUST, Kumasi, Ghana
| | | | - Dwomoa Adu
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Richard Adanu
- Ghana College of Physicians and Surgeon, Accra, Ghana
| | - Rulan S. Parekh
- Departments of Pediatrics and Medicine, Hospital for Sick Children, University of Health Network, University of Toronto, Toronto, Canada
| | - David Burke
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
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26
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Science M, Caldeira-Kulbakas M, Parekh RS, Maguire BR, Carroll S, Anthony SJ, Bitnun A, Bourns LE, Campbell DM, Cohen E, Dodds A, Dubey V, Friedman JN, Greenwood JL, Hopkins JP, Imgrund R, Korczak DJ, Looi T, Louca E, Mertz D, Nashid J, Panzera G, Schneiderman JE, Schwartz KL, Streitenberger L, Vuppal S, Walsh CM, Jüni P, Matava CT, Allen U, Alvares AD, Birken CS, Brown A, Carbone VL, Christie A, Cividino ME, Cohen-Silver JH, Cohn RD, Crosbie J, da Costa BR, Dharmaraj B, Freeman SJ, Gaebe K, Hajjaj O, Huang L, Khan S, Lee E, Logeman C, Manteghi S, Moore C, Morris SK, Orkin J, Pelger SD, Pickel L, Salman S, Shouldice A, Solomon R, Thampi N, Thorpe K, Wasiak A, Xie J. Effect of Wearing a Face Mask on Hand-to-Face Contact by Children in a Simulated School Environment: The Back-to-School COVID-19 Simulation Randomized Clinical Trial. JAMA Pediatr 2022; 176:1169-1175. [PMID: 36279142 PMCID: PMC9593317 DOI: 10.1001/jamapediatrics.2022.3833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE Wearing a face mask in school can reduce SARS-CoV-2 transmission but it may also lead to increased hand-to-face contact, which in turn could increase infection risk through self-inoculation. OBJECTIVE To evaluate the effect of wearing a face mask on hand-to-face contact by children while at school. DESIGN, SETTING, AND PARTICIPANTS This prospective randomized clinical trial randomized students from junior kindergarten to grade 12 at 2 schools in Toronto, Ontario, Canada, during August 2020 in a 1:1 ratio to either a mask or control class during a 2-day school simulation. Classes were video recorded from 4 angles to accurately capture outcomes. INTERVENTIONS Participants in the mask arm were instructed to bring their own mask and wear it at all times. Students assigned to control classes were not required to mask at any time (grade 4 and lower) or in the classroom where physical distancing could be maintained (grade 5 and up). MAIN OUTCOMES AND MEASURES The primary outcome was the number of hand-to-face contacts per student per hour on day 2 of the simulation. Secondary outcomes included hand-to-mucosa contacts and hand-to-nonmucosa contacts. A mixed Poisson regression model was used to derive rate ratios (RRs), adjusted for age and sex with a random intercept for class with bootstrapped 95% CIs. RESULTS A total of 174 students underwent randomization and 171 students (mask group, 50.6% male; control group, 52.4% male) attended school on day 2. The rate of hand-to-face contacts did not differ significantly between the mask and the control groups (88.2 vs 88.7 events per student per hour; RR, 1.00; 95% CI, 0.78-1.28; P = >.99). When compared with the control group, the rate of hand-to-mucosa contacts was significantly lower in the mask group (RR, 0.12; 95% CI, 0.07-0.21), while the rate of hand-to-nonmucosa contacts was higher (RR, 1.40; 95% CI, 1.08-1.82). CONCLUSIONS AND RELEVANCE In this clinical trial of simulated school attendance, hand-to-face contacts did not differ among students required to wear face masks vs students not required to wear face masks; however, hand-to-mucosa contracts were lower in the face mask group. This suggests that mask wearing is unlikely to increase infection risk through self-inoculation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04531254.
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monica Caldeira-Kulbakas
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rulan S. Parekh
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bryan R. Maguire
- Biostatistics Design and Analysis Unit, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacie Carroll
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Samantha J. Anthony
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Douglas M. Campbell
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Neonatal Intensive Care Unit, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada,Allan Waters Family Simulation Program, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Complex Care Program, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Alison Dodds
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vinita Dubey
- Communicable Disease Control, Toronto Public Health, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy N. Friedman
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jodi L. Greenwood
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Jessica P. Hopkins
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ryan Imgrund
- Biostatistics, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Daphne J. Korczak
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Looi
- Department of Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada,The Wilfred and Joyce Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emily Louca
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dominik Mertz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada,Department of Infection Prevention and Control, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John Nashid
- Corporate Strategy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giovanna Panzera
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Jane E. Schneiderman
- Division of Respiratory Medicine, Clinical Research Services, The Hospital for Sick Children, Toronto, Ontario, Canada,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Kevin L. Schwartz
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Division of Infectious Diseases, Department of Medicine, Unity Health Toronto, Toronto, Ontario, Canada
| | - Laurie Streitenberger
- Infection Prevention & Control (IPAC) Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunayna Vuppal
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catharine M. Walsh
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Jüni
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clyde T. Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Upton Allen
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Ahuva Brown
- for the Back-to-School COVID-19 School Study Group
| | | | | | | | | | | | | | | | | | | | | | - Omar Hajjaj
- for the Back-to-School COVID-19 School Study Group
| | - Lennox Huang
- for the Back-to-School COVID-19 School Study Group
| | - Sarah Khan
- for the Back-to-School COVID-19 School Study Group
| | - Eon Lee
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Clara Moore
- for the Back-to-School COVID-19 School Study Group
| | | | - Julia Orkin
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Soha Salman
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Nisha Thampi
- for the Back-to-School COVID-19 School Study Group
| | - Kevin Thorpe
- for the Back-to-School COVID-19 School Study Group
| | - Anna Wasiak
- for the Back-to-School COVID-19 School Study Group
| | - Jiayin Xie
- for the Back-to-School COVID-19 School Study Group
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Robinson CH, Parekh RS. Progress in Kidney Health in Low-Resource Settings: Building a More Equitable World—Introduction. Semin Nephrol 2022; 42:151339. [DOI: 10.1016/j.semnephrol.2023.151339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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28
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Coelho SG, Segovia A, Anthony SJ, Lin J, Pol S, Crosbie J, Science M, Matava CT, Parekh RS, Caldeira-Kulbakas M, Carroll S, Greenwood JL, Panzera G, Imgrund R, Osokin K, Korczak DJ. Le retour en classe et le port du masque pendant la pandémie de COVID-19 : le point de vue des élèves d’après une étude de simulation scolaire. Paediatr Child Health 2022; 27:S95-S102. [PMID: 36092299 PMCID: PMC9455641 DOI: 10.1093/pch/pxac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/22/2022] [Indexed: 11/14/2022] Open
Abstract
Objectifs La présente étude s’est penchée sur le point de vue des enfants relativement au retour en classe après le confinement imposé par la pandémie, sur le port du masque en classe et sur la santé mentale des enfants et des parents pendant la pandémie. Méthodologie La présente étude transversale a fait partie d’un exercice de simulation scolaire de deux jours au cours duquel les élèves ont été répartis au hasard entre diverses recommandations sur le port du masque. Au moyen d’analyses régression multiple, les chercheurs ont analysé le compte rendu des parents sur la santé mentale et, après la simulation, celui des élèves sur l’anxiété liée à la COVID-19 et le port du masque. Les élèves plus âgés ont participé à des groupes de travail semi-structurés pour compléter les données du questionnaire. Résultats Sur les 190 élèves de la présente étude, 31 % ne dépassaient pas la quatrième année et 95 % avaient hâte de rentrer en classe. La plus grande anxiété des parents ou des proches (β= 0,67; p <0,001) et leur niveau de scolarité plus bas (β=1,86; p <0,002) étaient prédicteurs d’une plus grande anxiété des enfants à l’égard de la COVID-19. Les élèves plus âgés étaient plus susceptibles de trouver le port du masque nuisible aux interactions avec leurs camarades que les plus jeunes (χ2[1]=31,16; p <0,001) et pour leur capacité à comprendre l’enseignant (χ2[1]=13,97; p <0,001). Les élèves du groupe sans masque étaient plus susceptibles de craindre de contracter la COVID-19 à l’école (χ2[1]=10,07; p <0,05) que ceux du groupe qui le portaient, et d’anticiper éprouver de la difficulté à le porter (χ2[1]=18,95; p <0,001). Conclusions Chez les enfants anxieux à cause de la COVID-19, l’anxiété des parents et l’information sur la COVID-19 pourraient être des cibles d’intervention. De futures recherches devraient porter sur les effets de la mise en œuvre prolongée de mesures sanitaires d’atténuation des risques sur la réussite scolaire et la santé mentale des enfants.
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Affiliation(s)
- Sophie G Coelho
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Alicia Segovia
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Samantha J Anthony
- Sciences évaluatives de la santé de l’enfant, The Hospital for Sick Children, Toronto (Ontario)Canada
- Faculté de travail social Factor-Inwentash, Université de Toronto, Toronto (Ontario)Canada
- Département de travail social, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Jia Lin
- Sciences évaluatives de la santé de l’enfant, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Sarah Pol
- Sciences évaluatives de la santé de l’enfant, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Jennifer Crosbie
- Département de psychiatrie, faculté de médecine, Université de Toronto, Toronto (Ontario)Canada
- Neurosciences et santé mentale, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Michelle Science
- Département de pédiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Clyde T Matava
- Département d’anesthésie et de médecine de la douleur, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département d’anesthésiologie et de médecine de la douleur, faculté de médecine, Université de Toronto, Toronto (Ontario)Canada
| | - Rulan S Parekh
- Département de pédiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Monica Caldeira-Kulbakas
- Département d’anesthésie et de médecine de la douleur, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Stacie Carroll
- Programme d’éducation et de partenariats communautaires, conseil scolaire du district de Toronto, Toronto (Ontario)Canada
- Soins centrés sur l’enfant et sur la famille, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Jodi L Greenwood
- Programme d’éducation et de partenariats communautaires, conseil scolaire du district de Toronto, Toronto (Ontario)Canada
- Soins centrés sur l’enfant et sur la famille, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Giovanna Panzera
- Programme d’éducation et de partenariats communautaires, conseil scolaire du district de Toronto, Toronto (Ontario)Canada
- Soins centrés sur l’enfant et sur la famille, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Ryan Imgrund
- Southlake Regional Health Centre, Newmarket (Ontario)Canada
- Conseil scolaire du district catholique de York, Toronto (Ontario)Canada
| | | | - Daphne J Korczak
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine, Université de Toronto, Toronto (Ontario)Canada
- Neurosciences et santé mentale, The Hospital for Sick Children, Toronto (Ontario)Canada
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de Verteuil I, Fitzpatrick J, Alvarez Elias AC, Banh T, Vasilevska-Ristovska J, Browne J, Bondi BC, Hui W, Slorach C, Wei Teoh C, Langlois V, Mertens L, Parekh RS. Longitudinal Changes in Cardiac Structure and Function in Pediatric Kidney Transplant Recipients. Hypertension 2022; 79:1680-1689. [PMID: 35652352 DOI: 10.1161/hypertensionaha.121.17483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Cardiovascular disease results in increased morbidity and mortality in pediatric kidney transplant recipients. Longitudinal changes in cardiac structure and function and the association with blood pressure control over time in pediatric kidney transplant recipients are unknown. METHODS To determine the influence of blood pressure control on cardiac changes following pediatric kidney transplant, we conducted a retrospective cohort study of children who received their first kidney transplant at the Hospital for Sick Children from 2004 to 2015. Children were followed until transfer to adult care or censoring in July 2018. Cardiac structure and function parameters were collected from clinical echocardiograms and assessed using standardized scores. Blood pressure control was determined by systolic blood pressure Z scores (above or below the 90th percentile) in combination with antihypertensive medications. A segmented mixed-effects model assessed Z scores of interventricular septum thickness, left ventricular end-diastolic dimension, and left ventricular posterior wall dimension. RESULTS Of 142 children included, 58% were men, mean age at transplant was 11 (±4.5) years, and average follow-up time was 4 (±3) years. All cardiac structural Z scores improved during follow-up. Interventricular septum thickness normalized at 4.0 years post-transplant. Left ventricular end-diastolic dimension normalized at 1.5 years post-transplant. Left ventricular posterior wall dimension normalized at 6.3 years post-transplant. Left ventricular mass index showed sustained improvement up to 12 years post-transplant. Individuals with uncontrolled blood pressure had increased left ventricular mass (β=2.97 [95% CI, 0.77-5.16]). CONCLUSIONS Cardiac structural abnormalities improve following kidney transplantation and normalize within 7 years, especially with controlled blood pressure. Strict blood pressure control is critical after pediatric kidney transplantation.
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Affiliation(s)
- Isabel de Verteuil
- Child Health Evaluative Sciences, Research Institute (I.d.V., J.F., T.B., J.V.-R., J.B., B.C.B., R.S.P.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica Fitzpatrick
- Child Health Evaluative Sciences, Research Institute (I.d.V., J.F., T.B., J.V.-R., J.B., B.C.B., R.S.P.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ana Catalina Alvarez Elias
- Division of Nephrology, (A.C.A.E., C.W.T., V.L., R.S.P.), The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation (A.C.A.E.), Toronto, Ontario, Canada
| | - Tonny Banh
- Child Health Evaluative Sciences, Research Institute (I.d.V., J.F., T.B., J.V.-R., J.B., B.C.B., R.S.P.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jovanka Vasilevska-Ristovska
- Child Health Evaluative Sciences, Research Institute (I.d.V., J.F., T.B., J.V.-R., J.B., B.C.B., R.S.P.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jordan Browne
- Child Health Evaluative Sciences, Research Institute (I.d.V., J.F., T.B., J.V.-R., J.B., B.C.B., R.S.P.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bianca C Bondi
- Child Health Evaluative Sciences, Research Institute (I.d.V., J.F., T.B., J.V.-R., J.B., B.C.B., R.S.P.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wei Hui
- Labatt Family Heart Center (W.H., C.S., L.M.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cameron Slorach
- Labatt Family Heart Center (W.H., C.S., L.M.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Chia Wei Teoh
- Division of Nephrology, (A.C.A.E., C.W.T., V.L., R.S.P.), The Hospital for Sick Children, Toronto, Ontario, Canada.,Temerty School of Medicine (C.W.T., V.L., L.M., R.S.P.), Toronto, Ontario, Canada
| | - Valerie Langlois
- Division of Nephrology, (A.C.A.E., C.W.T., V.L., R.S.P.), The Hospital for Sick Children, Toronto, Ontario, Canada.,Temerty School of Medicine (C.W.T., V.L., L.M., R.S.P.), Toronto, Ontario, Canada
| | - Luc Mertens
- Labatt Family Heart Center (W.H., C.S., L.M.), The Hospital for Sick Children, Toronto, Ontario, Canada.,Temerty School of Medicine (C.W.T., V.L., L.M., R.S.P.), Toronto, Ontario, Canada
| | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute (I.d.V., J.F., T.B., J.V.-R., J.B., B.C.B., R.S.P.), The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Nephrology, (A.C.A.E., C.W.T., V.L., R.S.P.), The Hospital for Sick Children, Toronto, Ontario, Canada.,Temerty School of Medicine (C.W.T., V.L., L.M., R.S.P.), Toronto, Ontario, Canada.,Toronto, Ontario, Canada and Dalla Lana School of Public Health (R.S.P.), Toronto, Ontario, Canada.,University of Toronto. University Health Network (R.S.P.) Toronto, Ontario, Canada
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Sachdeva M, Lara-Corrales I, Pope E, Chan AW, Parekh RS, Kitchlu A, Sibbald C. Incidence of and Risk Factors for Keratinocyte Carcinoma After Pediatric Solid Organ Transplant. JAMA Dermatol 2022; 158:828-831. [PMID: 35675056 DOI: 10.1001/jamadermatol.2022.1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Irene Lara-Corrales
- Division of Pediatric Dermatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elena Pope
- Division of Pediatric Dermatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - An-Wen Chan
- Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Canada.,Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Rulan S Parekh
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada.,Division of Pediatric Nephrology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medicine, Women's College Hospital Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abhijat Kitchlu
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Cathryn Sibbald
- Division of Pediatric Dermatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Canada
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31
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Coelho SG, Segovia A, Anthony SJ, Lin J, Pol S, Crosbie J, Science M, Matava CT, Parekh RS, Caldeira-Kulbakas M, Carroll S, Greenwood JL, Panzera G, Imgrund R, Osokin K, Korczak DJ. Return to school and mask-wearing in class during the COVID-19 pandemic: Student perspectives from a school simulation study. Paediatr Child Health 2022; 27:S15-S21. [PMID: 35620563 PMCID: PMC9126272 DOI: 10.1093/pch/pxab102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives This study examined children’s perspectives about returning to in-person school following lockdown due to the pandemic and about mask-wearing in class, as well as the mental health of children and parents during the pandemic. Methods This cross-sectional study was part of a 2-day school simulation exercise that randomized students to different masking recommendations. Parent-report of mental health and post-simulation child-report of COVID-19-related anxiety and mask-wearing were analyzed using descriptive and multiple regression analyses. Semi-structured focus groups were conducted with older students to supplement questionnaire data. Results Of 190 students in this study, 31% were in grade 4 or lower 95% looked forward to returning to in-person school. Greater child anxiety about COVID-19 was predicted by increased parent/caregiver anxiety (β=0.67; P<0.001), and lower parental educational attainment (β=1.86; P<0.002). Older students were more likely than younger students to report that mask-wearing interfered with their abilities to interact with peers (χ2(1)=31.16; P<0.001) and understand the teacher (χ2(1)=13.97; P<0.001). Students in the group that did not require masks were more likely than students in the masking group to report worries about contracting COVID-19 at school (χ2(1)=10.07; P<0.05), and anticipated difficulty wearing a mask (χ2(1)=18.95; P<0.001). Conclusions For children anxious about COVID-19, parental anxiety and education about COVID-19 may be targets for intervention. Future research should examine the impact of prolonged implementation of public health mitigation strategies in school on academic achievement and children’s mental health.
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Affiliation(s)
- Sophie G Coelho
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alicia Segovia
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha J Anthony
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.,Department of Social Work, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jia Lin
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Pol
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle Science
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Clyde T Matava
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rulan S Parekh
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Monica Caldeira-Kulbakas
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacie Carroll
- Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada.,Child and Family Centered Care, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jodi L Greenwood
- Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada.,Child and Family Centered Care, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giovanna Panzera
- Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada.,Child and Family Centered Care, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ryan Imgrund
- Southlake Regional Health Centre, Newmarket, Ontario, Canada.,York Catholic District School Board, Toronto, Ontario, Canada
| | | | - Daphne J Korczak
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
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32
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Tran MA, Chad L, Parekh RS, Bismilla Z. A 5-year-old girl with abdominal pain, headache, and cracked lips. Paediatr Child Health 2022; 27:70-71. [DOI: 10.1093/pch/pxab054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/19/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- My-An Tran
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Lauren Chad
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Rulan S Parekh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Zia Bismilla
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Lin J, Pol SJ, Korczak DJ, Coelho S, Segovia A, Matava CT, Parekh RS, Science M, Caldeira-Kulbakas M, Crosbie J, Carroll S, Greenwood JL, Panzera G, Imgrund R, Anthony SJ. Impact of COVID-19 Public Health Protocols on Teachers Instructing Children and Adolescents During an In-Person Simulation. J Can Acad Child Adolesc Psychiatry 2022; 31:52-63. [PMID: 35614958 PMCID: PMC9084371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 12/09/2021] [Indexed: 06/15/2023]
Abstract
Objective As a result of the COVID-19 pandemic, public health agencies and school boards across Canada enacted new protocols, including face masks, physical distancing and enhanced hygiene, to support the safe reopening of in-person school. This study explored the experiences and perceptions of teachers instructing children and adolescents in person during a two-day school simulation. Method This study was part of a large school simulation exercise conducted in Toronto, Ontario. Kindergarten to grade 12 teachers taught in classrooms with either masked students, or students who were un-masked or only masked when physical distancing was not possible. A qualitative descriptive phenomenology approach was utilized, and data were collected via virtual focus groups. Qualitative data analysis involved multiple rounds of inductive coding to generate themes. Results The sample included 14 teachers (92.9% female; 85.7% White), with a median of 9.5 years teaching experience. Three primary themes emerged: 1) learning to navigate public health measures, 2) needing to adapt teaching strategies and 3) striving to manage conflicting priorities. The majority of teachers reported that mask-wearing and physical distancing impacted their classroom teaching, communication and connection with students. Conclusions As schools transition to in-person instruction, teachers will be required to play dual roles in education and public health, with implications on safety, teaching and professional identity. Public health agencies and school boards are encouraged to engage teachers in ongoing conversations regarding in-person school planning and operations. Furthermore, evidence-based interventions, including increased teaching development programs, are recommended to support teachers during the COVID-19 pandemic.
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Affiliation(s)
- Jia Lin
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
| | - Sarah J Pol
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
| | - Daphne J Korczak
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Sophie Coelho
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario
| | - Alicia Segovia
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario
| | - Clyde T Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Rulan S Parekh
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario
| | - Michelle Science
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario
| | | | - Jennifer Crosbie
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario
| | - Stacie Carroll
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario
- Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario
| | - Jodi L Greenwood
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario
- Toronto District School Board, Toronto, Ontario
| | - Giovanna Panzera
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario
- Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario
| | - Ryan Imgrund
- York Catholic District School Board, Aurora, Ontario
| | - Samantha J Anthony
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario
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34
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Affiliation(s)
- Rulan S Parekh
- Department of Medicine (Parekh, Perl, Auguste), University of Toronto; Division of Nephrology (Parekh), Women's College Hospital; Department of Pediatrics (Parekh), The Hospital for Sick Children, University of Toronto; Division of Nephrology (Perl), St. Michael's Hospital, Unity Health; Division of Nephrology (Auguste), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Medicine and the Ottawa Hospital Research Institute (Sood), The Ottawa Hospital, Ottawa, Ont.
| | - Jeffrey Perl
- Department of Medicine (Parekh, Perl, Auguste), University of Toronto; Division of Nephrology (Parekh), Women's College Hospital; Department of Pediatrics (Parekh), The Hospital for Sick Children, University of Toronto; Division of Nephrology (Perl), St. Michael's Hospital, Unity Health; Division of Nephrology (Auguste), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Medicine and the Ottawa Hospital Research Institute (Sood), The Ottawa Hospital, Ottawa, Ont
| | - Bourne Auguste
- Department of Medicine (Parekh, Perl, Auguste), University of Toronto; Division of Nephrology (Parekh), Women's College Hospital; Department of Pediatrics (Parekh), The Hospital for Sick Children, University of Toronto; Division of Nephrology (Perl), St. Michael's Hospital, Unity Health; Division of Nephrology (Auguste), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Medicine and the Ottawa Hospital Research Institute (Sood), The Ottawa Hospital, Ottawa, Ont
| | - Manish M Sood
- Department of Medicine (Parekh, Perl, Auguste), University of Toronto; Division of Nephrology (Parekh), Women's College Hospital; Department of Pediatrics (Parekh), The Hospital for Sick Children, University of Toronto; Division of Nephrology (Perl), St. Michael's Hospital, Unity Health; Division of Nephrology (Auguste), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Medicine and the Ottawa Hospital Research Institute (Sood), The Ottawa Hospital, Ottawa, Ont
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Currie EG, Coburn B, Porfilio EA, Lam P, Rojas OL, Novak J, Yang S, Chowdhury RB, Ward LA, Wang PW, Khaleghi K, An J, Crome SQ, Hladunewich MA, Barbour SJ, Cattran DC, Parekh RS, Licht C, John R, Kaul R, Croitoru K, Gray-Owen SD, Guttman DS, Gommerman JL, Reich HN. Immunoglobulin A nephropathy is characterized by anti-commensal humoral immune responses. JCI Insight 2022; 7:141289. [PMID: 35133979 PMCID: PMC8983137 DOI: 10.1172/jci.insight.141289] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
IgA nephropathy (IgAN) is a leading cause of kidney failure, yet little is known about the immunopathogenesis of this disease. IgAN is characterized by deposition of IgA in the kidney glomeruli, but the source and stimulus for IgA production are not known. Clinical and experimental data suggest a role for aberrant immune responses to mucosal microbiota in IgAN, and in some countries with high disease prevalence, tonsillectomy is regarded as standard-of-care therapy. To evaluate the relationship between microbiota and mucosal immune responses, we characterized the tonsil microbiota in patients with IgAN versus nonrelated household-matched control group participants and identified increased carriage of the genus Neisseria and elevated Neisseria-targeted serum IgA in IgAN patients. We reverse-translated these findings in experimental IgAN driven by BAFF overexpression in BAFF-transgenic mice rendered susceptible to Neisseria infection by introduction of a humanized CEACAM-1 transgene (B × hC-Tg). Colonization of B × hC-Tg mice with Neisseria yielded augmented levels of systemic Neisseria-specific IgA. Using a custom ELISPOT assay, we discovered anti-Neisseria–specific IgA-secreting cells within the kidneys of these mice. These findings suggest a role for cytokine-driven aberrant mucosal immune responses to oropharyngeal pathobionts, such as Neisseria, in the immunopathogenesis of IgAN. Furthermore, in the presence of excess BAFF, pathobiont-specific IgA can be produced in situ within the kidney.
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Affiliation(s)
- Elissa G Currie
- Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Bryan Coburn
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Elisa A Porfilio
- Department of Immunology, University of Toronto, Toronto, Canada
| | - Ping Lam
- Division of Nephrology, Toronto General Research Institute, Toronto, Canada
| | - Olga L Rojas
- Department of Immunology, University of Toronto, Toronto, Canada
| | - Jan Novak
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, United States of America
| | - Stuart Yang
- Division of Nephrology, Toronto General Research Institute, Toronto, Canada
| | - Raad B Chowdhury
- Division of Nephrology, Toronto General Research Institute, Toronto, Canada
| | - Lesley A Ward
- Department of Immunology, University of Toronto, Toronto, Canada
| | - Pauline W Wang
- Department of Cell & Systems Biology, University of Toronto, Toronto, Canada
| | | | - James An
- Division of Nephrology, Toronto General Research Institute, Toronto, Canada
| | - Sarah Q Crome
- Division of Nephrology, Toronto General Research Institute, Toronto, Canada
| | | | - Sean J Barbour
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Daniel C Cattran
- Division of Nephrology, University Health Network, Toronto, Canada
| | - Rulan S Parekh
- Department of Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Christoph Licht
- Department of Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Rohan John
- Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Canada
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Kenneth Croitoru
- Division of Gastroenterology, Mount Sinai Hospital, Toronto, Canada
| | - Scott D Gray-Owen
- Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - David S Guttman
- Department of Cell & Systems Biology, University of Toronto, Toronto, Canada
| | | | - Heather N Reich
- Division of Nephrology, University Health Network, Toronto, Canada
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36
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Sachdeva M, Lara-Corrales I, Pope E, Chan AW, Parekh RS, Kitchlu A, Sibbald C. Outcomes of skin cancers in pediatric solid organ transplant patients: A systematic review. Pediatr Transplant 2022; 26:e14146. [PMID: 34562053 DOI: 10.1111/petr.14146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The most frequently reported malignancies after solid organ transplant are cutaneous, but data on the risk in pediatric populations varies across studies. OBJECTIVES To perform a systematic review including reported features and outcomes of skin cancers in pediatric solid organ transplant recipients. METHODS EMBASE and MEDLINE were systematically searched (Prospero CRD42020201659). RESULTS The review summarizes data from 20 studies on 337 patients, with a median age ranging from 15.0 to 19.5 years as reported in 4 studies, who developed skin malignancies after pediatric solid organ transplantation. Median ages at transplant and skin cancer diagnosis ranged from 1.5 to 17.0 years and 15.3 to 33.5 years, respectively. Squamous cell carcinoma (SCC) was most commonly reported (218 cases), followed by basal cell carcinoma (BCC) (91 cases), melanoma (18 cases), and unspecified keratinocyte carcinomas (2 cases). The median latency period between transplantation and cancer diagnosis ranged from 2.2 to 21.0 years. Overall, 4 studies reported 17 cases of metastasis in total, and recurrence was reported in one case. Six deaths were reported in one study related to SCC and melanoma metastases. The incidence rate of skin cancer after pediatric transplantation per 100 person-years of follow-up was 2.1 based on 5 studies. CONCLUSION The most frequent post-transplant malignancy in pediatric organ transplant recipients was SCC.
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Affiliation(s)
| | - Irene Lara-Corrales
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Elena Pope
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - An-Wen Chan
- Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Rulan S Parekh
- Division of Pediatric Nephrology, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada.,Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Abhijat Kitchlu
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Cathryn Sibbald
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, ON, Canada
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37
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Watt J, Fitzpatrick J, Sozio SM, Jaar BG, Estrella MM, Tereshchenko LG, Monroy-Trujillo JM, Walsh M, Parekh RS. Association of abnormal electrocardiograph metrics with prolonged recovery time in incident hemodialysis patients. BMC Nephrol 2022; 23:46. [PMID: 35086494 PMCID: PMC8796483 DOI: 10.1186/s12882-022-02664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients receiving intermittent hemodialysis have variable times of recovery to feeling better after dialysis. QT prolongation, a precursor to clinical and subclinical cardiovascular events, may contribute to delayed recovery time. We hypothesized that abnormal electrocardiographic parameters indicating perturbations in ventricular action are associated with longer recovery times thus impacting a patient-centered quality of life. METHODS Among 242 incident in-center hemodialysis participants from the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study, corrected QT interval (QTc), QRST angle and heart rate variance were measured on non-dialysis days using a standard 5-min electrocardiograph recording. Left ventricular hypertrophy (LVH) was defined using the Cornell voltage product. Recovery time was ascertained during a phone interview with a standardized validated questionnaire. Associations between QTc, QRST angle, heart rate variance, and LVH and natural log-transformed recovery time were examined using linear regression adjusted for participant characteristics and electrolytes. RESULTS Mean age was 55 (standard deviation 13) years, 55% were male, 72% were African American. Longer QTc interval was associated with increased recovery time (per 10 ms increase in QTc, recovery time increased by 6.2%; 95% confidence interval: 0.0-10.5). QRST angle, heart rate, heart rate variability and LVH were not significantly associated with recovery time. CONCLUSION Longer QTc intervals are associated with longer recovery time independent of serum electrolytes. This supports a relationship between a patient's underlying arrhythmic status and time to recovery after hemodialysis. Future studies will determine if maneuvers to reduce QTc improves recovery time and quality of life of patients on hemodialysis.
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Affiliation(s)
- Jacqueline Watt
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica Fitzpatrick
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Bernard G Jaar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Nephrology Center of Maryland, Baltimore, MD, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, USA
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Larisa G Tereshchenko
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Michael Walsh
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rulan S Parekh
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
- Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
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Krissberg JR, Helmuth ME, Almaani S, Cai Y, Cattran D, Chatterjee D, Gbadegesin RA, Gibson KL, Glenn DA, Greenbaum LA, Iragorri S, Jain K, Khalid M, Kidd JM, Kopp JB, Lafayette R, Nestor JG, Parekh RS, Reidy KJ, David T Selewski, John Sperati C, Tuttle KR, Twombley K, Vasylyeva TL, Weaver DJ, Wenderfer SE, O'Shaughnessy MM. Racial-ethnic differences in health-related quality of life among adults and children with glomerular disease. Glomerular Dis 2021; 1:105-117. [PMID: 34723246 DOI: 10.1159/000516832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction Disparities in health-related quality of life (HRQOL) have been inadequately studied in patients with glomerular disease. The aim of this study was to identify relationships between race/ethnicity, socioeconomic status, disease severity, and HRQOL in an ethnically and racially diverse cohort of patients with glomerular disease. Methods Cure Glomerulonephropathy (CureGN) is a multinational cohort study of patients with biopsy-proven glomerular disease. Associations between race/ethnicity and HRQOL were determined by the following: 1. Missed school or work due to kidney disease; 2. Responses to Patient Reported Outcomes Measurement Information System (PROMIS) questionnaires. We adjusted for demographics, socioeconomic status, and disease characteristics using multivariable logistic and linear regression. Results Black and Hispanic participants had worse socioeconomic status and more severe glomerular disease than White or Asian participants. Black adults missed work or school most frequently due to kidney disease (30% versus 16-23% in the other three groups, p=0.04), and had the worst self-reported global physical health (median score 44.1 versus 48.0-48.2, p<0.001) and fatigue (53.8 versus 48.5-51.1, p=0.002), compared to other racial/ethnic groups. However, these findings were not statistically significant with adjustment for socioeconomic status and disease severity, both of which were strongly associated with HRQOL in adults. Among children, disease severity but not race/ethnicity or socioeconomic status were associated with HRQOL. Conclusions Among patients with glomerular disease enrolled in CureGN, the worse HRQOL reported by Black adults was attributable to lower socioeconomic status and more severe glomerular disease. No racial/ethnic differences in HRQOL were observed in children.
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Affiliation(s)
- Jill R Krissberg
- Division of Nephrology, Department of Pediatrics, Stanford University, Stanford, California, United States
| | - Margaret E Helmuth
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
| | - Salem Almaani
- Department of Nephrology, The Ohio State University, Columbus, Ohio, United States
| | - Yi Cai
- Division of Pediatric Nephrology, Helen DeVos Children's Hospital, Grand Rapids, Michigan, United States
| | - Daniel Cattran
- Division of Nephrology, University Health Network, University of Toronto, Ontario, Canada
| | - Debanjana Chatterjee
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, United States
| | - Rasheed A Gbadegesin
- Department of Pediatrics, Duke University, Durham, North Carolina, United States
| | - Keisha L Gibson
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Dorey A Glenn
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Laurence A Greenbaum
- Division of Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Sandra Iragorri
- Division of Nephrology and Hypertension, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, United States
| | - Koyal Jain
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Myda Khalid
- Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jason M Kidd
- Division of Nephrology, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Jeffrey B Kopp
- Kidney Disease Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States
| | - Richard Lafayette
- Division of Nephrology and Hypertension, Stanford University, Stanford, California, United States
| | - Jordan G Nestor
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, United States
| | - Rulan S Parekh
- Division of Nephrology, Department of Paediatrics, Hospital for Sick Children, University Health Network and University of Toronto, Toronto, Canada
| | - Kimberly J Reidy
- Department of Pediatric Nephrology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, United States
| | - David T Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States
| | - C John Sperati
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Katherine R Tuttle
- Division of Nephrology, University of Washington, Seattle, Washington, United States
| | - Katherine Twombley
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Tetyana L Vasylyeva
- Division of Nephrology, Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| | - Donald Jack Weaver
- Division of Pediatric Nephrology, Atrium Health Levine Children's, Charlotte, North Carolina, United States
| | - Scott E Wenderfer
- Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
| | - Michelle M O'Shaughnessy
- Department of Renal Medicine, Cork University Hospital and University College Cork, Cork, Ireland
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Wine R, Vasilevska-Ristovska J, Banh T, Knott J, Noone D, Gbadegesin R, Ilori TO, Okafor HU, Furia F, Ulasi I, Solarin AU, Esezobor C, Batte A, Raji Y, Olanrewaju TO, Muoneke U, Adetunji AE, Boima V, Amira O, Osafo C, Guemkam G, Ajayi S, Makusidi MA, Anigilaje EA, Ruggajo P, Asinobi AO, Ademola AD, Parekh RS. Trends in the epidemiology of childhood nephrotic syndrome in Africa: A systematic review. Glob Epidemiol 2021; 3:100061. [PMID: 37635724 PMCID: PMC10445969 DOI: 10.1016/j.gloepi.2021.100061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background Childhood nephrotic syndrome, if left untreated, leads to progressive kidney disease or death. We quantified the prevalence of steroid-sensitive nephrotic syndrome, steroid-resistant nephrotic syndrome, and histological types as the epidemiology of nephrotic syndrome in Africa remains unknown, yet impacts outcomes. Methods We searched MEDLINE, Embase, African Journals Online, and WHO Global Health Library for articles in any language reporting on childhood nephrotic syndrome in Africa from January 1, 1946 to July 1, 2020. Primary outcomes included steroid response, biopsy defined minimal change disease, and focal segmental glomerulosclerosis (FSGS) by both pooled and individual proportions across regions and overall. Findings There were 81 papers from 17 countries included. Majority of 8131 children were steroid-sensitive (64% [95% CI: 63-66%]) and the remaining were steroid-resistant (34% [95% CI: 33-35%]). Of children biopsied, pathological findings were 38% [95% CI: 36-40%] minimal change, 24% [95% CI: 22-25%] FSGS, and 38% [95% CI: 36-40%] secondary causes of nephrotic syndrome. Interpretation Few African countries reported on the prevalence of childhood nephrotic syndrome. Steroid-sensitive disease is more common than steroid-resistant disease although prevalence of steroid-resistant nephrotic syndrome is higher than reported globally. Pathology findings suggest minimal change and secondary causes are common. Scarcity of data in Africa prevents appropriate healthcare resource allocation to diagnose and treat this treatable childhood kidney disease to prevent poor health outcomes. Funding Funding was provided by the Canadian Institute for Health Research (CIHR) and the National Institute of Health (NIH) for the H3 Africa Kidney Disease Research Network. This research was undertaken, in part, from the Canada Research Chairs program.
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Affiliation(s)
- Rachel Wine
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Tonny Banh
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Janae Knott
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Damien Noone
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rasheed Gbadegesin
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Titilayo O. Ilori
- Renal Section, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Henrietta U. Okafor
- Department of Pediatrics, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Francis Furia
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ifeoma Ulasi
- Department of Pediatrics, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Adaobi U. Solarin
- Department of Paediatrics & Child Health, Faculty of Clinical Sciences, Lagos State College of Medicine, Ikeja, Lagos, Nigeria
| | - Christopher Esezobor
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Anthony Batte
- Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Yemi Raji
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Timothy O. Olanrewaju
- Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Uzoamaka Muoneke
- Department of Pediatrics, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Adewale E. Adetunji
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Oluwatoyin Amira
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Charlotte Osafo
- The Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Georgette Guemkam
- Pediatric Nephrology, Mother and Child Center, Chantal BIYA Foundation, Yaounde, Cameroon
| | - Samuel Ajayi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
- University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Muhammad A. Makusidi
- Division of Nephrology, Department of Internal Medicine, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Emmanuel A. Anigilaje
- Nephrology Unit, Department of Pediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Paschal Ruggajo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Adanze O. Asinobi
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Adebowale D. Ademola
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Rulan S. Parekh
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
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Science M, Bolotin S, Silverman M, Nadarajah J, Maguire B, Parekh RS, McGeer A, Schwartz KL, Alexander L, Allen U, Ariyarajah A, Castellani L, Cohn RD, Downing M, Katz K, Kazmi K, Leis JA, Liu D, Pernica JM, Schneiderman JE, Sumaida M, Campigotto A. SARS-CoV-2 antibodies in Ontario health care workers during and after the first wave of the pandemic: a cohort study. CMAJ Open 2021; 9:E929-E939. [PMID: 34642255 PMCID: PMC8513603 DOI: 10.9778/cmajo.20210044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Health care workers have a critical role in the pandemic response to COVID-19 and may be at increased risk of infection. The objective of this study was to assess the seroprevalence of SARS-CoV-2 immunoglobulin G (IgG) antibodies among health care workers during and after the first wave of the pandemic. METHODS We conducted a prospective multicentre cohort study involving health care workers in Ontario, Canada, to detect IgG antibodies against SARS-CoV-2. Blood samples and self-reported questionnaires were obtained at enrolment, at 6 weeks and at 12 weeks. A community hospital, tertiary care pediatric hospital and a combined adult-pediatric academic health centre enrolled participants from Apr. 1 to Nov. 13, 2020. Predictors of seropositivity were evaluated using a multivariable logistic regression, adjusted for clustering by hospital site. RESULTS Among the 1062 health care workers participating, the median age was 40 years, and 834 (78.5%) were female. Overall, 57 (5.4%) were seropositive at any time point (2.5% when participants with prior infection confirmed by polymerase chain reaction testing were excluded). Seroprevalence was higher among those who had a known unprotected exposure to a patient with COVID-19 (p < 0.001) and those who had been contacted by public health because of a nonhospital exposure (p = 0.003). Providing direct care to patients with COVID-19 or working on a unit with a COVID-19 outbreak was not associated with higher seroprevalence. In multivariable logistic regression, presence of symptomatic contacts in the household was the strongest predictor of seropositivity (adjusted odds ratio 7.15, 95% confidence interval 5.42-9.41). INTERPRETATION Health care workers exposed to household risk factors were more likely to be seropositive than those not exposed, highlighting the need to emphasize the importance of public health measures both inside and outside of the hospital.
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont.
| | - Shelly Bolotin
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Michael Silverman
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Jeya Nadarajah
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Bryan Maguire
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Rulan S Parekh
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Allison McGeer
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Kevin L Schwartz
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Laura Alexander
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Upton Allen
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Archchun Ariyarajah
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Lucas Castellani
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Ronald D Cohn
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Mark Downing
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Kevin Katz
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Kescha Kazmi
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Jerome A Leis
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Derek Liu
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Jeffrey M Pernica
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Jane E Schneiderman
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Maya Sumaida
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Aaron Campigotto
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont.
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Robinson CH, Jeyakumar N, Luo B, Wald R, Garg AX, Nash DM, McArthur E, Greenberg JH, Askenazi D, Mammen C, Thabane L, Goldstein S, Parekh RS, Zappitelli M, Chanchlani R. Long-Term Kidney Outcomes Following Dialysis-Treated Childhood Acute Kidney Injury: A Population-Based Cohort Study. J Am Soc Nephrol 2021; 32:2005-2019. [PMID: 34039667 PMCID: PMC8455253 DOI: 10.1681/asn.2020111665] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/23/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AKI is common during pediatric hospitalizations and associated with adverse short-term outcomes. However, long-term outcomes among survivors of pediatric AKI who received dialysis remain uncertain. METHODS To determine the long-term risk of kidney failure (defined as receipt of chronic dialysis or kidney transplant) or death over a 22-year period for pediatric survivors of dialysis-treated AKI, we used province-wide health administrative databases to perform a retrospective cohort study of all neonates and children (aged 0-18 years) hospitalized in Ontario, Canada, from April 1, 1996, to March 31, 2017, who survived a dialysis-treated AKI episode. Each AKI survivor was matched to four hospitalized pediatric comparators without dialysis-treated AKI, on the basis of age, sex, and admission year. We reported the incidence of each outcome and performed Cox proportional hazards regression analyses, adjusting for relevant covariates. RESULTS We identified 1688 pediatric dialysis-treated AKI survivors (median age 5 years) and 6752 matched comparators. Among AKI survivors, 53.7% underwent mechanical ventilation and 33.6% had cardiac surgery. During a median 9.6-year follow-up, AKI survivors were at significantly increased risk of a composite outcome of kidney failure or death versus comparators. Death occurred in 113 (6.7%) AKI survivors, 44 (2.6%) developed kidney failure, 174 (12.1%) developed hypertension, 213 (13.1%) developed CKD, and 237 (14.0%) had subsequent AKI. AKI survivors had significantly higher risks of developing CKD and hypertension versus comparators. Risks were greatest in the first year after discharge and gradually decreased over time. CONCLUSIONS Survivors of pediatric dialysis-treated AKI are at higher long-term risks of kidney failure, death, CKD, and hypertension, compared with a matched hospitalized cohort.
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Affiliation(s)
- Cal H. Robinson
- Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Bin Luo
- ICES, London, Ontario, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael’s Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Jason H. Greenberg
- Division of Nephrology, Department of Pediatrics, Yale University, New Haven, Connecticut
| | - David Askenazi
- Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cherry Mammen
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lehana Thabane
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada,Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada,Biostatistics Unit, St Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Stuart Goldstein
- Center for Acute Care Nephrology, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Rulan S. Parekh
- Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Zappitelli
- Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rahul Chanchlani
- ICES, London, Ontario, Canada,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada,Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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42
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Fitzpatrick J, Sozio SM, Jaar BG, Estrella MM, Segev DL, Shafi T, Monroy-Trujillo JM, Parekh RS, McAdams-DeMarco MA. Frailty, Age, and Postdialysis Recovery Time in a Population New to Hemodialysis. Kidney360 2021; 2:1455-1462. [PMID: 35373112 PMCID: PMC8786133 DOI: 10.34067/kid.0001052021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
Background Frailty, a phenotype characterized by decreased physiologic reserve and the inability to recover following confrontation with a stressor like hemodialysis, may help identify which patients on incident hemodialysis will experience longer postdialysis recovery times. Recovery time is associated with downstream outcomes, including quality of life and mortality. We characterized postdialysis recovery times among patients new to hemodialysis and quantified the association between frailty and hemodialysis recovery time. Methods Among 285 patients on hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study, frailty was measured using the Fried phenotype. Self-reported recovery time was obtained by telephone interview. We estimated the association of frailty (intermediately frail and frail versus nonfrail) and postdialysis recovery time using adjusted negative binomial regression. Results Median time between dialysis initiation and study enrollment was 3.4 months (IQR, 2.7-4.9), and that between initiation and recovery time assessment was 11 months (IQR, 9.3-15). Mean age was 55 years, 24% were >65 years, and 73% were Black; 72% of individuals recovered in ≤1 hour, 20% recovered in 1-6 hours, 5% required 6-12 hours to recover, and <5% required >12 hours to recover. Those with intermediate frailty, frailty, and age ≤65 years had 2.56-fold (95% CI, 1.45 to 4.52), 1.72-fold (95% CI, 1.03 to 2.89), and 2.35-fold (95% CI, 1.44 to 3.85) risks, respectively, of longer recovery time independent of demographic characteristics, comorbidity, and dialysis-related factors. Conclusions In adults new to hemodialysis, frailty was independently associated with prolonged postdialysis recovery. Future studies should assess the effect of frailty-targeted interventions on recovery time to improve clinical outcomes.
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Affiliation(s)
- Jessica Fitzpatrick
- Department of Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen M. Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland
| | - Bernard G. Jaar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Nephrology Center of Maryland, Baltimore, Maryland
| | - Michelle M. Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California,Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Dorry L. Segev
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Tariq Shafi
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi,Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Rulan S. Parekh
- Department of Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada
| | - Mara A. McAdams-DeMarco
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Department of Surgery, Johns Hopkins University, Baltimore, Maryland
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43
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Bello AK, McIsaac M, Okpechi IG, Johnson DW, Jha V, Harris DC, Saad S, Zaidi D, Osman MA, Ye F, Lunney M, Jindal K, Klarenbach S, Kalantar-Zadeh K, Kovesdy CP, Parekh RS, Prasad B, Khan M, Riaz P, Tonelli M, Wolf M, Levin A. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in North America and the Caribbean. Kidney Int Suppl (2011) 2021; 11:e66-e76. [PMID: 33981472 PMCID: PMC8084729 DOI: 10.1016/j.kisu.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 10/21/2022] Open
Abstract
The International Society of Nephrology established the Global Kidney Health Atlas project to define the global capacity for kidney replacement therapy and conservative kidney care, and this second iteration was to describe the availability, accessibility, quality, and affordability of kidney failure (KF) care worldwide. This report presents results for the International Society of Nephrology North America and the Caribbean region. Relative to other regions, the North America and Caribbean region had better infrastructure and funding for health care and more health care workers relative to the population. Various essential medicines were also more available and accessible. There was substantial variation in the prevalence of treated KF in the region, ranging from 137.4 per million population (pmp) in Jamaica to 2196 pmp in the United States. A mix of public and private funding systems cover costs for nondialysis chronic kidney disease care in 60% of countries and for dialysis in 70% of countries. Although the median number of nephrologists is 18.1 (interquartile range, 15.3-29.5) pmp, which is approximately twice the global median of 9.9 (interquartile range, 1.2-22.7) pmp, some countries reported shortages of other health care workers. Dialysis was available in all countries, but peritoneal dialysis was underutilized and unavailable in Barbados, Cayman Islands, and Turks and Caicos. Kidney transplantation was primarily available in Canada and the United States. Economic factors were the major barriers to optimal KF care in the Caribbean countries, and few countries in the region have chronic kidney disease-specific national health care policies. To address regional gaps in KF care delivery, efforts should be directed toward augmenting the workforce, improving the monitoring and reporting of kidney replacement therapy indicators, and implementing noncommunicable disease and chronic kidney disease-specific policies in all countries.
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Affiliation(s)
- Aminu K. Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Mark McIsaac
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ikechi G. Okpechi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - David W. Johnson
- Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translation Research Institute, Brisbane, Queensland, Australia
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David C.H. Harris
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Syed Saad
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed A. Osman
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kailash Jindal
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Scott Klarenbach
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine Medical Center, Orange, California, USA
| | - Csaba P. Kovesdy
- Division of Nephrology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Rulan S. Parekh
- Division of Nephrology, Department of Pediatrics and Medicine, Hospital for Sick Children, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bhanu Prasad
- Section of Nephrology, Department of Medicine, Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Maryam Khan
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Parnian Riaz
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - ISN North America and the Caribbean Regional Board
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
- Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translation Research Institute, Brisbane, Queensland, Australia
- George Institute for Global Health, University of New South Wales, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine Medical Center, Orange, California, USA
- Division of Nephrology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
- Division of Nephrology, Department of Pediatrics and Medicine, Hospital for Sick Children, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Section of Nephrology, Department of Medicine, Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
- Division of Nephrology, Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Fitzpatrick J, Kerns ES, Kim ED, Sozio SM, Jaar BG, Estrella MM, Tereshchenko LG, Monroy-Trujillo JM, Parekh RS, Bourjeily G. Functional outcomes of sleep predict cardiovascular intermediary outcomes and all-cause mortality in incident hemodialysis patients. J Clin Sleep Med 2021; 17:1707-1715. [PMID: 33779539 DOI: 10.5664/jcsm.9304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Patients with end-stage kidney disease (ESKD) commonly experience sleep disturbances. Sleep disturbance has been inconsistently associated with mortality risk in hemodialysis patients, but the burden of symptoms from sleep disturbances has emerged as a marker that may shed light on these discrepancies and guide treatment decisions. This study examines whether functional outcomes of sleep are associated with increased risk of intermediary CV outcomes or mortality among adults initiating hemodialysis. METHODS In 228 participants enrolled in the Predictors of Arrhythmic and Cardiovascular risk in ESRD (PACE) study, the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10), which assesses functional outcomes of daytime sleepiness, was administered within 6 months of enrollment. Intermediary CV outcomes included QTc [ms], heart rate variance [ms²], left ventricular mass index [g/m², LVMI], and left ventricular hypertrophy [LVH]. The association of FOSQ-10 score with all-cause mortality was examined using proportional hazards regression. Results: Mean age was 55 years, median BMI was 28 kg/m² (IQR 24,33), with 70% African Americans. Median FOSQ-10 score was 19.7 (IQR: 17.1,20.0). A 10% lower FOSQ-10 score was associated with increased mortality risk (HR 1.09, 95%CI 1.01-1.18). Lower FOSQ-10 scores were associated with longer QTc duration and lower heart rate variance, but not LVMI or LVH. CONCLUSIONS In adults initiating dialysis, sleep-related functional impairment is common and is associated with intermediary cardiovascular disease measures and increased mortality risk. Future studies should assess the impact of screening for sleep disturbances in ESKD patients to identify individuals at increased risk for cardiovascular complications and death.
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Affiliation(s)
- Jessica Fitzpatrick
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric S Kerns
- Lahey Hospital and Medical Center, Burlington, MA
| | - Esther D Kim
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
| | - Stephen M Sozio
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bernard G Jaar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Nephrology Center of Maryland, Baltimore, MD
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco and Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
| | - Larisa G Tereshchenko
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health and Science University, Portland, OR
| | | | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada
| | - Ghada Bourjeily
- Department of Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI
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Esezobor C, Ademola AD, Adetunji AE, Anigilaje EA, Batte A, Jiya-Bello FN, Furia FF, Muoneke U, McCulloch M, Nourse P, Obiagwu P, Odetunde O, Okyere P, Solarin A, Tannor EK, Noone D, Gbadegesin R, Parekh RS. Management of idiopathic childhood nephrotic syndrome in sub-Saharan Africa: Ibadan consensus statement. Kidney Int 2021; 99:59-67. [PMID: 32866504 PMCID: PMC10069409 DOI: 10.1016/j.kint.2020.07.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/24/2020] [Accepted: 07/17/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Christopher Esezobor
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Adebowale D Ademola
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Adewale E Adetunji
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Emmanuel A Anigilaje
- Nephrology Unit, Department of Pediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Anthony Batte
- Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Francis F Furia
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Uzoamaka Muoneke
- Department of Pediatrics, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | | | - Peter Nourse
- Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | | | | | - Perditer Okyere
- Department of Internal Medicine, Komfo Anokye Teaching Hospital, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Adaobi Solarin
- Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria
| | | | - Damien Noone
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rasheed Gbadegesin
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rulan S Parekh
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Chen W, Fitzpatrick J, Sozio SM, Jaar BG, Estrella MM, Riascos-Bernal DF, Wu TT, Qiu Y, Kurland IJ, Dubin RF, Chen Y, Parekh RS, Bushinsky DA, Sibinga NE. Identification of Novel Biomarkers and Pathways for Coronary Artery Calcification in Nondiabetic Patients on Hemodialysis Using Metabolomic Profiling. Kidney360 2020; 2:279-289. [PMID: 34723191 PMCID: PMC8553022 DOI: 10.34067/kid.0004422020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A better understanding of the pathophysiology involving coronary artery calcification (CAC) in patients on hemodialysis (HD) will help to develop new therapies. We sought to identify the differences in metabolomics profiles between patients on HD with and without CAC. METHODS In this case-control study, nested within a cohort of 568 incident patients on HD, the cases were patients without diabetes with a CAC score >100 (n=51), and controls were patients without diabetes with a CAC score of zero (n=48). We measured 452 serum metabolites in each participant. Metabolites and pathway scores were compared using Mann-Whitney U tests, partial least squares-discriminant analyses, and pathway enrichment analyses. RESULTS Compared with controls, cases were older (64±13 versus 42±12 years) and were less likely to be Black (51% versus 94%). We identified three metabolites in bile-acid synthesis (chenodeoxycholic, deoxycholic, and glycolithocholic acids) and one pathway (arginine/proline metabolism). After adjusting for demographics, higher levels of chenodeoxycholic, deoxycholic, and glycolithocholic acids were associated with higher odds of having CAC; comparing the third with the first tertile of each bile acid, the OR was 6.34 (95% CI, 1.12 to 36.06), 6.73 (95% CI, 1.20 to 37.82), and 8.53 (95% CI, 1.50 to 48.49), respectively. These associations were no longer significant after further adjustment for coronary artery disease and medication use. Per 1 unit higher in the first principal component score, arginine/proline metabolism was associated with CAC after adjusting for demographics (OR, 1.83; 95% CI, 1.06 to 3.15), and the association remained significant with additional adjustments for statin use (OR, 1.84; 95% CI, 1.04 to 3.27). CONCLUSIONS Among patients on HD without diabetes mellitus, chenodeoxycholic, deoxycholic, and glycolithocholic acids may be potential biomarkers for CAC, and arginine/proline metabolism is a plausible mechanism to study for CAC. These findings need to be confirmed in future studies.
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Affiliation(s)
- Wei Chen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York,Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Jessica Fitzpatrick
- Department of Medicine and Pediatrics, Hospital for Sick Children and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Stephen M. Sozio
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Baltimore, Maryland
| | - Bernard G. Jaar
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Baltimore, Maryland,Nephrology Center of Maryland, Fallston, Maryland
| | - Michelle M. Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco, San Francisco, California,San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Dario F. Riascos-Bernal
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York,Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Yunping Qiu
- Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, New York
| | - Irwin J. Kurland
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York,Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ruth F. Dubin
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Yabing Chen
- Department of Pathology, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Rulan S. Parekh
- Department of Medicine and Pediatrics, Hospital for Sick Children and University Health Network, University of Toronto, Toronto, Ontario, Canada,Department of Epidemiology, Bloomberg School of Public Health, Baltimore, Maryland
| | - David A. Bushinsky
- Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Nicholas E.S. Sibinga
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York,Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York
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Chen TK, Fitzpatrick J, Winkler CA, Binns-Roemer EA, Corona-Villalobos CP, Jaar BG, Sozio SM, Parekh RS, Estrella MM. APOL1 Risk Variants and Subclinical Cardiovascular Disease in Incident Hemodialysis Patients. Kidney Int Rep 2020; 6:333-341. [PMID: 33615058 PMCID: PMC7879092 DOI: 10.1016/j.ekir.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/23/2020] [Accepted: 11/10/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction To better understand the impact of APOL1 risk variants in end-stage renal disease (ESRD) we evaluated associations of APOL1 risk variants with subclinical cardiovascular disease (CVD) and mortality among African Americans initiating hemodialysis and enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD cohort study. Methods We modeled associations of APOL1 risk status (high = 2; low = 0/1 risk alleles) with baseline subclinical CVD (left ventricular [LV] hypertrophy; LV mass; ejection fraction; coronary artery calcification [CAC]; pulse wave velocity [PWV]) using logistic and linear regression and all-cause or cardiovascular mortality using Cox models, adjusting for age, sex, and ancestry. In sensitivity analyses, we further adjusted for systolic blood pressure and Charlson Comorbidity Index. Results Of 267 African American participants successfully genotyped for APOL1, 27% were high-risk carriers, 41% were women, and mean age was 53 years. At baseline, APOL1 high- versus low-risk status was independently associated with 50% and 53% lower odds of LV hypertrophy and CAC, respectively, and 10.7% lower LV mass. These associations were robust to further adjustment for comorbidities but not systolic blood pressure. APOL1 risk status was not associated with all-cause or cardiovascular mortality (mean follow-up 2.5 years). Conclusion Among African American patients with incident hemodialysis, APOL1 high-risk status was associated with better subclinical measures of CVD but not mortality.
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Affiliation(s)
- Teresa K. Chen
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Correspondence: Teresa K. Chen, Division of Nephrology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 416, Baltimore, Maryland 21287, USA.
| | - Jessica Fitzpatrick
- Departments of Pediatrics and Medicine, Hospital for Sick Children, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Cheryl A. Winkler
- Basic Research Program, Frederick National Laboratory, Frederick, Maryland, USA
| | | | - Celia P. Corona-Villalobos
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bernard G. Jaar
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nephrology Center of Maryland, Baltimore, Maryland, USA
| | - Stephen M. Sozio
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rulan S. Parekh
- Departments of Pediatrics and Medicine, Hospital for Sick Children, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Michelle M. Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- San Francisco VA Health Care System, San Francisco, California, USA
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Chen W, Fitzpatrick J, Monroy-Trujillo JM, Sozio SM, Jaar BG, Estrella MM, Serrano J, Anokhina V, Miller BL, Melamed ML, Bushinsky DA, Parekh RS. Associations of Serum Calciprotein Particle Size and Transformation Time With Arterial Calcification, Arterial Stiffness, and Mortality in Incident Hemodialysis Patients. Am J Kidney Dis 2020; 77:346-354. [PMID: 32800846 DOI: 10.1053/j.ajkd.2020.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/20/2020] [Indexed: 01/09/2023]
Abstract
RATIONALE & OBJECTIVE Characteristics of the transformation of primary to secondary calciprotein particles (CPPs) in serum, including the size of secondary CPP (CPP2) aggregates and the time of transformation (T50), may be markers for arterial calcification in patients undergoing hemodialysis (HD). We examined the associations of CPP2 aggregate size and T50 with arterial calcification in incident HD patients. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Incident HD patients (n=402with available CPP2 measures and n=388with available T50 measures) from the Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) Study PREDICTORS: Serum CPP2 size and T50 at baseline. OUTCOMES Primary outcomes were baseline coronary artery and thoracic aorta calcifications. Exploratory outcomes included baseline arterial stiffness, measured by pulse wave velocity (PWV) and ankle brachial index, and longitudinally, repeat measures of PWV and all-cause mortality. ANALYTICAL APPROACH Tobit regression, multiple linear regression, Poisson regression, linear mixed-effects regression, and Cox proportional hazards regression. RESULTS Mean age was 55±13 years, 41% were women, 71% were Black, and 57% had diabetes mellitus. Baseline CPP2 size and T50 were correlated with baseline fetuin A level (r=-0.59 for CPP2 and 0.44 for T50; P<0.001 for both), but neither was associated with baseline measures of arterial calcification or arterial stiffness. Baseline CPP2 size and T50 were not associated with repeat measures of PWV. During a median follow-up of 3.5 (IQR, 1.7-6.2) years, larger CPP2 was associated with higher risk for mortality (HR, 1.17 [95% CI, 1.05-1.31] per 100nm larger CPP2 size) after adjusting for demographics and comorbid conditions, but there was no association between baseline T50 and risk for mortality. LIMITATIONS Possible imprecision in assays, small sample size, limited generalizability to incident HD populations with different racial composition, and residual confounding. CONCLUSIONS In incident HD patients, neither CPP2 size nor T50 was associated with prevalent arterial calcification and stiffness. Larger CPP2 was associated with risk for mortality, but this finding needs to be confirmed in future studies.
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Affiliation(s)
- Wei Chen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Jessica Fitzpatrick
- Department of Medicine and Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Stephen M Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Bloomberg School of Public Health, Baltimore, MD
| | - Bernard G Jaar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Bloomberg School of Public Health, Baltimore, MD; Nephrology Center of Maryland, Baltimore, MD
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA; San Francisco VA Health Care System, San Francisco, CA
| | - Jishyra Serrano
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Viktoriya Anokhina
- Departments of Biochemistry and Biophysics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Benjamin L Miller
- Departments of Biochemistry and Biophysics, University of Rochester School of Medicine and Dentistry, Rochester, NY; Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY; Biomedical Engineering, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Michal L Melamed
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - David A Bushinsky
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Rulan S Parekh
- Department of Medicine and Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Epidemiology, Bloomberg School of Public Health, Baltimore, MD
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Fitzpatrick J, Kim ED, Sozio SM, Jaar BG, Estrella MM, Monroy-Trujillo JM, Parekh RS. Calcification Biomarkers, Subclinical Vascular Disease, and Mortality Among Multiethnic Dialysis Patients. Kidney Int Rep 2020; 5:1729-1737. [PMID: 33102965 PMCID: PMC7569684 DOI: 10.1016/j.ekir.2020.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 06/21/2020] [Accepted: 07/28/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction Vascular calcification and stiffness are associated with higher mortality and cardiovascular disease in hemodialysis patients, but the underlying mechanism is not well elucidated and previous studies have been contradictory. We sought to determine the association of circulating calcification biomarkers with calcification, stiffness, and mortality in a multiethnic incident dialysis population. Methods Among 391 incident hemodialysis participants enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study, we examined the cross-sectional associations of baseline fibroblast growth factor 23 (FGF23), desphospho-uncarboxylated matrix Gla protein (dp-ucMGP), fetuin-A, and osteoprotegerin (OPG) according to total coronary artery calcium score (CAC, using the Agatston calcification criteria) at baseline, vascular stiffness (pulse wave velocity [PWV]) over 4 study visits, and all-cause mortality. Results Patients' mean age was 55 years; 40% were female, 72% were African American, and 58% had diabetes. Higher OPG and FGF23 were associated with a 1.09-fold (per 5-pmol/l increase in OPG; 95% confidence interval [CI]: 1.01-1.17) and 1.12-fold (per increase of 100 log RU/ml in FGF23; 95% CI: 1.02‒1.34) higher prevalence of CAC, independent of demographics, comorbidities, dialysis factors, and serum klotho levels. Higher OPG was associated with higher baseline PWV. Higher FGF23 was associated with lower PWV over follow-up. dp-ucMGP and fetuin-A were not associated with either CAC or vascular stiffness. After adjustment, circulating biomarkers were not associated with mortality risk. Conclusion Several circulating calcification biomarkers were only modestly associated with subclinical cardiovascular disease in an incident multiethnic hemodialysis population; none were associated with mortality. Understanding whether these associations persist in larger, diverse hemodialysis populations is warranted before planning trials.
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Affiliation(s)
- Jessica Fitzpatrick
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Esther D Kim
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
| | - Stephen M Sozio
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bernard G Jaar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Nephrology Center of Maryland, Baltimore, Maryland, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, San Franscisco, California, USA.,Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA
| | - Jose M Monroy-Trujillo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada
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50
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Bondi BC, Banh TM, Vasilevska-Ristovska J, Szpindel A, Chanchlani R, Hebert D, Solomon M, Dipchand AI, Kim SJ, Ng VL, Parekh RS. Incidence and Risk Factors of Obesity in Childhood Solid-Organ Transplant Recipients. Transplantation 2020; 104:1644-1653. [PMID: 32732843 DOI: 10.1097/tp.0000000000003025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity is a significant public health concern; however, the incidence post solid-organ transplantation is not well reported. METHODS This study determined the incidence and risk factors of obesity among pediatric solid-organ transplant recipients (heart, lung, liver, kidney, multiorgan) at The Hospital for Sick Children (2002-2011), excluding prevalent obesity. Follow-up occurred from transplantation until development of obesity, last follow-up, or end of study. Incidence of obesity was determined overall, by baseline body mass index, and organ group. Risk factors were assessed using Cox proportional-hazards regression. RESULTS Among 410 (55% male) children, median transplant age was 8.9 (interquartile range [IQR]: 1.0-14.5) years. Median follow-up time was 3.6 (IQR: 1.5-6.4) years. Incidence of obesity was 65.2 (95% confidence interval [CI]: 52.7-80.4) per 1000 person-years. Overweight recipients had a higher incidence, 190.4 (95% CI: 114.8-315.8) per 1000 person-years, than nonoverweight recipients, 56.1 (95% CI: 44.3-71.1). Cumulative incidence of obesity 5-years posttransplant was 24.1%. Kidney relative to heart recipients had the highest risk (3.13 adjusted hazard ratio [aHR]; 95% CI: 1.53-6.40) for obesity. Lung and liver recipients had similar rates to heart recipients. Those with higher baseline body mass index (z-score; 1.72 aHR; 95% CI: 1.39-2.14), overweight status (2.63 HR; 95% CI: 1.71-4.04), and younger transplant age (y; 1.18 aHR; 95% CI: 1.12-1.25) were at highest risk of obesity. Higher cumulative steroid dosage (per 10 mg/kg) was associated with increased risk of obesity after adjustment. CONCLUSIONS Among all transplanted children at The Hospital for Sick Children, 25% developed obesity within 5-years posttransplant. Kidney recipients, younger children, those overweight at transplant, and those with higher cumulative steroid use (per 10 mg/kg) were at greatest risk. Early screening and intervention for obesity are important preventative strategies.
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Affiliation(s)
- Bianca C Bondi
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tonny M Banh
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Aliya Szpindel
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rahul Chanchlani
- Division of Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Diane Hebert
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Pediatric Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Melinda Solomon
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Respiratory Medicine, Hospital for Sick Children, ON, Canada
| | - Anne I Dipchand
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Labatt Family Heart Centre, Hospital for Sick Children, Toronto, ON, Canada
| | - S Joseph Kim
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Vicky L Ng
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada
| | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Pediatric Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Canada Research Chair (Tier 1) in Chronic Kidney Disease Epidemiology, University of Toronto, Canadian Institutes of Health Research, Toronto, ON, Canada
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